Individual
NICOLE AVILA-PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1550 S PIONEER WAY STE 165, MOSES LAKE, WA 98837-4637
(509) 793-9780
(509) 764-3244
Mailing address
660 S COOLIDGE ST, MOSES LAKE, WA 98837-1872
(509) 493-9715
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60633381
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295192540
—
WA
05
—
2056200
—
WA
01
—
G8985877
MEDICARE PIN
WA
01
—
P01626675
RR MEDICARE WVH
WA
Enumeration date
01/18/2016
Last updated
01/11/2022
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