# LIBERTY LAKE DIRECT PRIMARY CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Liberty Lake DPC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558048280
- **Authorized official:** DR. JARED W. NELSON M.D. (OWNER)
- **Authorized official phone:** (509) 828-5250

## Contact information

- **Practice address:** 2207 N MOLTER RD, LIBERTY LAKE, WA 99019-7570
- **Practice address phone:** (509) 348-2214
- **Mailing address:** 704 N MADSON CT, LIBERTY LAKE, WA 99019-7507
- **Mailing address phone:** (509) 828-5250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/04/2023
- **Last updated:** 07/04/2023