Timothy C Wical Jr., BSN, DNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60961155 Issued in WA

Practice address

15406 Meridian E
Puyallup, WA 98375-9504

Phone

(253) 509-1777

Fax

(949) 577-4515

NPI assigned

Oct 31, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1013469592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 JONES BRIDGE RD",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144712",
            "telephone_number": "301-295-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15406 MERIDIAN E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983759504",
            "telephone_number": "253-509-1777",
            "fax_number": "949-577-4515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICAL",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "BSN, DNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-31",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60961155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.