Awh Evergreen PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

AWH EVERGREEN PC

Practice address

18209 State Route 410 E Ste 303
Bonney Lake, WA 98391-5146

Phone

(725) 204-6055

NPI assigned

Jul 8, 2025

Last updated

Jul 8, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda Wilkinson

Title

Director of Operations

Phone

(725) 204-6055

Specialties & licenses 1

Addresses

Other names 1

• Ageless Women's Health Other name

Locations

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

{
    "created_epoch": "1751932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1205726353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10501 W GOWAN RD STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891296602",
            "telephone_number": "725-204-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18209 STATE ROUTE 410 E STE 303",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915146",
            "telephone_number": "725-204-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWH EVERGREEN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-08",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "725-204-6055"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Women's Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Providers in Bonney Lake, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; 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.