Provider Demographics
NPI:1780988154
Name:MOORES, STEPHANIE A (ARNP, BC)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:MOORES
Suffix:
Gender:F
Credentials:ARNP, BC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:AHRENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26117 124TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7974
Mailing Address - Country:US
Mailing Address - Phone:509-981-3180
Mailing Address - Fax:425-313-2817
Practice Address - Street 1:1851 CENTRAL PL S
Practice Address - Street 2:SUITE 123
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7514
Practice Address - Country:US
Practice Address - Phone:509-981-3180
Practice Address - Fax:206-721-3063
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006104363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health