# TRI-CITIES INFUSION AND WELLNESS CLINIC

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

## Provider details

- **NPI number:** 1417415530
- **Authorized official:** TYLER THORNOCK CRNA (GOVENOR)
- **Authorized official phone:** (435) 668-4334

## Contact information

- **Practice address:** 7211 W DESCHUTES AVE STE D202, KENNEWICK, WA 99336-7715
- **Practice address phone:** (435) 668-3443
- **Mailing address:** 15205 S MOUNTAIN RIDGE CT, KENNEWICK, WA 99338-8325
- **Mailing address phone:** (435) 668-4334

## Taxonomy

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

## Other

- **Enumeration date:** 03/07/2019
- **Last updated:** 07/18/2019