Provider Demographics
NPI:1326079336
Name:RAGSDALE, SALLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359860
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-4191
Mailing Address - Fax:206-744-8527
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359860
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-4191
Practice Address - Fax:206-744-8527
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006539363LA2200X, 363LG0600X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9640921Medicaid
WA43115UOtherREGENCE BLUE SHIELD PIN
WA0197291OtherL&I PIN
WA0197291OtherL&I PIN
Q50205Medicare UPIN