Provider Demographics
NPI:1760104566
Name:TKACHEV, AMY R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:TKACHEV
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 ROAD F NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8739
Mailing Address - Country:US
Mailing Address - Phone:509-793-6850
Mailing Address - Fax:
Practice Address - Street 1:3220 ROAD F NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-8739
Practice Address - Country:US
Practice Address - Phone:509-793-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61343076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner