Amanda Reed Proctor

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP61250114 Issued in WA

Practice address

905 E D St
Deer Park, WA 99006-5167

Phone

(509) 276-5005

Fax

(509) 276-7785

NPI assigned

Jan 10, 2022

Last updated

Jun 15, 2023By the provider in NPPES

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BCHGAA

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.

• Deer Park Family Care Clinic PS

  dba Deer Park Family Care Clinic

  • Family Medicine Physician
  • Deer Park, WA
  • NPI 1548294150
  Medicare reassignment NPD
• Public Hospital District No 1 of Mason County

  dba Mason Health-Mason General Hospital

  • Critical Access Hospital
  • Shelton, WA
  • NPI 1760568752
  Medicare reassignment NPD
• Deer Park Urgent Care PLLC

  dba Deer Park Urgent Care

  • Urgent Care Clinic/Center
  • Deer Park, WA
  • NPI 1093741076

  Family Medicine

  NPD
• Public Hospital District No 1 of Mason County

  dba MGH Family Health, Ankle and Foot

  • Family Medicine Physician
  • Shelton, WA
  • NPI 1134573272
  NPD
• Public Hospital District No 1 of Mason County Wa

  dba Mason General Hospital Mountain View Women's Health

  • Clinic/Center
  • Shelton, WA
  • NPI 1316174774
  NPD

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1831850023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MOUNTAIN VIEW DR",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844401",
            "telephone_number": "509-496-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E D ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990065167",
            "telephone_number": "509-276-5005",
            "fax_number": "509-276-7785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24261 N US Highway 101",
            "address_purpose": "LOCATION",
            "city": "Hoodsport",
            "state": "WA",
            "postal_code": "985489456",
            "country_code": "US",
            "telephone_number": "360-432-7781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "702 S Park St",
            "address_purpose": "LOCATION",
            "city": "Deer Park",
            "state": "WA",
            "postal_code": "990067025",
            "country_code": "US",
            "telephone_number": "509-262-9000",
            "fax_number": "509-276-3034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "AMANDA",
        "middle_name": "REED",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61250114",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "F10211086",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Jane Porter, LMP
• Privia Medical Group Washington, PLLC
• Privia Medical Group Washington, PLLC (Deer Park Urgent Care)
• Privia Medical Group Washington, PLLC (Deer Park Urgent Care)
• Privia Medical Group Washington, PLLC (Deer Park Family Care Clinic)
• Sarah Lynn Puthoff
• Stephanie Quackenbush, COTA/L
• Revive Therapeutic Massage
• Taryn Marie Ridley, DPT
• Andrew S Roberts, DPT

• Nurse Practitioner in Deer Park, WA
• Providers in Deer Park, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.