Provider Demographics
NPI:1013786680
Name:PRATER, ALSTON MABON
Entity Type:Individual
Prefix:
First Name:ALSTON
Middle Name:MABON
Last Name:PRATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W JAMES LN APT 1H13
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4670
Mailing Address - Country:US
Mailing Address - Phone:206-604-4377
Mailing Address - Fax:
Practice Address - Street 1:1420 W JAMES LN APT 1H13
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4670
Practice Address - Country:US
Practice Address - Phone:206-604-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC61304150376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide