# PRUDENT MEDICAL PROVIDERS NW

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- **Entity:** Organization
- **Status:** Active
- **Other names:** N/A
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699364455
- **Authorized official:** KRISTYN DICE (CONTRACTING MANAGER)
- **Authorized official phone:** (208) 717-3944

## Contact information

- **Practice address:** 1045 S 320TH ST STE 7, FEDERAL WAY, WA 98003-5179
- **Practice address phone:** (206) 212-6554
- **Mailing address:** 4523 42ND ST NE, TACOMA, WA 98422-2424
- **Mailing address phone:** (206) 245-4902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/15/2021
- **Last updated:** 07/13/2023