Provider Demographics
NPI:1811394935
Name:SHEALY, PHILLIP LUTHER (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LUTHER
Last Name:SHEALY
Suffix:
Gender:M
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23745 225TH WAY SE
Mailing Address - Street 2:STE 201
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5294
Mailing Address - Country:US
Mailing Address - Phone:803-943-8358
Mailing Address - Fax:
Practice Address - Street 1:801 SW 16TH ST.
Practice Address - Street 2:STE. 121
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2628
Practice Address - Country:US
Practice Address - Phone:206-805-8885
Practice Address - Fax:206-805-8886
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60508185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily