Provider Demographics
NPI:1629528732
Name:BYRD, MARRIAH KAY (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARRIAH
Middle Name:KAY
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 U ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2571
Mailing Address - Country:US
Mailing Address - Phone:360-560-1195
Mailing Address - Fax:
Practice Address - Street 1:3514 U ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2571
Practice Address - Country:US
Practice Address - Phone:360-560-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60681608172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker