Provider Demographics
NPI:1972508836
Name:HARTLEY, JAMES WILLIAM (ARNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:J.
Other - Middle Name:WILLIAM
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:240 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9515
Mailing Address - Country:US
Mailing Address - Phone:360-303-8797
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-6434
Practice Address - Fax:360-848-4233
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0528363LF0000X
WAAP30006842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1972508836Medicaid
WA264365OtherLABOR & INDUSTRIES
WAG8892837Medicare PIN