Tatyana B Peck, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

10634 E Riverside Dr
Suite 130
Bothell, WA 98011-3757

Phone

(425) 806-5021

Fax

(425) 486-3949

NPI assigned

Feb 19, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sound 50 clinicians

Ellie Mental Health of Estero 6 clinicians

Ellie Mental Health of Naples at 75 Vineyards Blvd 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Ellie Mental Health of Estero

  • Mental Health Counselor
  • Estero, FL
  • NPI 1851029243

  FL

  Medicare reassignment Care Compare group NPD
• Sound

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tukwila, WA
  • NPI 1780774950

  WA

  Medicare reassignment Care Compare group
• Ellie Mental Health of Naples at 75 Vineyards Blvd

  • Mental Health Counselor
  • Naples, FL
  • NPI 1619605706

  FL

  Medicare reassignment Care Compare group
• Puget Sound Psychiatric Center, PS

  • Psychiatry Physician
  • Bothell, WA
  • NPI 1114254729

  WA

  Medicare reassignment

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1669611380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1287",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980411287",
            "telephone_number": "425-806-5021",
            "fax_number": "425-486-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10634 E RIVERSIDE DR",
            "address_2": "SUITE 130",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113757",
            "telephone_number": "425-806-5021",
            "fax_number": "425-486-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "TATYANA",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-19",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "TA60056707",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Dawn Pazier, PT
• Peace & Comfort Afh LLC
• Peacehealth Networks on Demand, LLC
• Ann Pearce
• Ryan Pebles
• Pediatric Associates, Inc., Dba Allegro Pediatrics
• Peixi Liao Professional Services
• Peixi Liao PS
• Calvin Pelkola, CBT
• Audra Pellegrini

• All providers in Bothell, WA
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.