Provider Demographics
NPI:1619438041
Name:ATKINS, JAMIE RAYE (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAYE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CANAL DR NE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-9547
Mailing Address - Country:US
Mailing Address - Phone:360-350-4010
Mailing Address - Fax:360-533-9825
Practice Address - Street 1:516 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4106
Practice Address - Country:US
Practice Address - Phone:360-350-4010
Practice Address - Fax:360-533-9825
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00052520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA33-0652655Medicaid