# NORTHWEST KETAMINE CLINICS TACOMA, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215528732
- **Authorized official:** ALLYN D WILCOCK ARNP (OWNER)
- **Authorized official phone:** (206) 330-6722

## Contact information

- **Practice address:** 1901 S UNION AVE, BUILDING B, SUITE 4001, TACOMA, WA 98405
- **Practice address phone:** (206) 309-2299
- **Practice address fax:** (425) 256-3250
- **Mailing address:** 35302 SE CENTER ST, SNOQUALMIE, WA 98065-9216
- **Mailing address phone:** (206) 330-6722
- **Mailing address fax:** (425) 256-3250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2021
- **Last updated:** 01/27/2021