Provider Demographics
NPI:1528306594
Name:LIPKE, TAMMY GAYLE (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:GAYLE
Last Name:LIPKE
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 164TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8080
Mailing Address - Country:US
Mailing Address - Phone:940-536-9440
Mailing Address - Fax:
Practice Address - Street 1:1718 164TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8080
Practice Address - Country:US
Practice Address - Phone:940-536-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123012363LF0000X
WAAP60866580363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337579202Medicaid
TX337579203Medicaid
TX337579201Medicaid
TX359086YKP5Medicare PIN
TX359086YKQLMedicare PIN
TX359086YKPWMedicare PIN