Individual provider Active NPI

Amanda R Flyckt, ARNP

  • Nurse Practitioner
  • Olympia, WA
National Provider Identifier
1386912897
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60520308 Issued in WA
Practice address
413 Lilly Rd NE
PMG SW Wa PSPH Hospitalists
Olympia, WA 98506-5133
Phone
(360) 493-4069
NPI assigned
Dec 12, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP60520308 WA Primary

Addresses

Primary practice location

413 Lilly Rd NE
PMG SW Wa PSPH Hospitalists
Olympia, WA 98506-5133

Mailing address

PO Box 3360
Portland, OR 97208-3360

Other practice location 1

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

Other identifiers 1

IdentifierTypeStateIssuer
2041629MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aflyckt481528@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150122001427 WA Practitioner - Nurse Practitioner 5294994299 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians
Washington Pac Services PCGroup PAC ID 4082986070, 43 clinicians
CS Pacs 3 Northwest LLCGroup PAC ID 8729526496, 26 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

630 S Pearl St
Tacoma, WA 98465-2111
Phone (253) 671-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
AP60520308WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Mar 21, 2022 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Washington Pac Services PC CurrentSince Dec 8, 2025 Accepting new patients
Franciscan Medical Group CurrentSince Mar 21, 2022 Accepting new patients
Wa Pacs 2 PC CurrentSince Dec 8, 2025 Accepting new patients
Comprehensive Postacute Care PLLC CurrentSince Jul 22, 2020 Accepting new patients
Alliance for South Sound Health CurrentSince Nov 2, 2021 Accepting new patients
CS Pacs 3 Northwest, LLC CurrentSince Dec 8, 2025 Accepting new patients

Locations

414 17th St SE
Auburn, WA 98002
Phone (253) 320-0748

21008 76th Ave W
Edmonds, WA 98026
Phone (425) 778-0107

135 S 336th St
Federal Way, WA 98003
Phone (253) 835-7433

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

920 12th Ave SE
Puyallup, WA 98372
Phone (253) 841-3422

3600 E Hartson Ave
Spokane, WA 99202
Phone (509) 468-7000

414 S University Rd
Spokane Valley, WA 99206
Phone (509) 924-4650

14820 E 4th Ave
Spokane Valley, WA 99216
Phone (509) 922-1644

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

3402 S 19th St
Tacoma, WA 98405
Phone (253) 301-5400

11315 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 588-1711

630 S Pearl St
Tacoma, WA 98465
Phone (253) 564-7111

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: aflyckt481528@wm.providencedirect.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1386912897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY RD NE",
            "address_2": "PMG SW WA PSPH HOSPITALISTS",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065133",
            "telephone_number": "360-493-4069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 S J St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054933",
            "country_code": "US",
            "telephone_number": "253-426-6341",
            "fax_number": "253-426-6344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLYCKT",
        "first_name": "AMANDA",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-12",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60520308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2041629",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aflyckt481528@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "413 Lilly Rd NE",
            "address_2": "PMG SW WA PSPH Hospitalists",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985065133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.