Provider Demographics
NPI:1760416325
Name:MYERS-CLEARY, CARRIE LYNNE (ARNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:MYERS-CLEARY
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 1:28011 NE 48TH WAY
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7107
Mailing Address - Country:US
Mailing Address - Phone:360-833-1764
Mailing Address - Fax:
Practice Address - Street 1:900 NE 139TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2518
Practice Address - Country:US
Practice Address - Phone:360-433-0022
Practice Address - Fax:360-433-6159
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003269363LF0000X, 363LP2300X
OR200250171NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9609561Medicaid
WAQ11643Medicare UPIN
WA8854310Medicare ID - Type Unspecified