Provider Demographics
NPI:1790417137
Name:MOREHART, ALLIE GRACE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ALLIE
Middle Name:GRACE
Last Name:MOREHART
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 1:25603 138TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-8822
Mailing Address - Country:US
Mailing Address - Phone:406-788-3844
Mailing Address - Fax:
Practice Address - Street 1:1201 PACIFIC AVE STE 1910
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4315
Practice Address - Country:US
Practice Address - Phone:253-572-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61219469163WG0000X
WA61465181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNO OTHER NUMBERS