Provider Demographics
NPI:1700055795
Name:PATTERSON, WALTER ROYAL JR (ARNP)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ROYAL
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 169TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2259
Mailing Address - Country:US
Mailing Address - Phone:253-446-6798
Mailing Address - Fax:
Practice Address - Street 1:11102 SUNRISE BLVD. E., STE. 103
Practice Address - Street 2:WOODCREEK HEALTHCARE
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00148862163WH0200X
WAAP60432813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00148862OtherHEALTH PROFESSIONS QA DIV
WAAP60432813OtherDSHS