Provider Demographics
NPI:1760416325
Name:MYERS-CLEARY, CARRIE LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:MYERS-CLEARY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:541-278-4332
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:222 NE PARK PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:360-254-8618
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003269363LF0000X, 363LP2300X
OR200250171NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9609561Medicaid
WAQ11643Medicare UPIN
WA8854310Medicare ID - Type Unspecified