MISS TRACIE MARIE JEFFERSON (NPI# 1346642832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346642832 |
| Entity Type | Individual |
| Full Name | MISS TRACIE MARIE JEFFERSON |
| Credential | PA-C |
| Practice Address |
11216 Sunrise Blvd E Ste 3-106 Puyallup WA 98374-8848 |
| Mailing Address |
3908 10th St Se Puyallup WA 98374-2188 |
| Practice Telephone | 2538485951 |
| Practice Fax Number | 2538457073 |
| Mailing Telephone | 2538485951 |
| Mailing Fax Number | 2538457073 |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2017-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363A00000X | Physician Assistant | PA60596875 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2048296 | 05 |
| Street Address |
11216 SUNRISE BLVD E STE 3-106 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98374-8848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851818280 | Patricia Solomos | Nurse Practitioner | 11216 Sunrise Blvd E Ste 3-106, Puyallup, WA 98374-8848 | 2017-08-25 |
| 1841724788 | Ryan Patrick Kraeger | Physician Assistant | 11216 Sunrise Blvd E Ste 3-106, Puyallup, WA 98374-8848 | 2017-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073173977 | Courtney Yant | Registered Nurse | 300 3rd St Se, Puyallup, WA 98374 | 2019-06-13 |
| 1013480508 | Tracy Pina | Massage Therapist | 16909 123rd Ave E, Puyallup, WA 98374 | 2019-01-07 |
| 1922524917 | Edith M Wood | Registered Nurse | 13517 152nd St Ct E, Puyallup, WA 98374 | 2017-08-21 |
| 1669875993 | Jillian C S Longway | Registered Nurse | 11102 Sunrise Blvd E Ste 103, Puyallup, WA 98374 | 2014-10-01 |
| 1427302025 | Nadeem Jaffer | Internal Medicine | 3800 3rd St. Se, Puyallup, WA 98374 | 2012-11-04 |
| 1851605356 | Madigan Army Medical Ctr | Clinic/Center | 15600 Meridan Ave, Sunrise Village Center, East Puyallup, WA 98374 | 2010-07-27 |
| 1326368135 | Matt Karl Jahns | Massage Therapist | 2402 20th St Se, Puyallup, WA 98374 | 2010-06-03 |
| 1982833208 | Roxy Sturgeon | Speech-Language Pathologist | 2309 43rd Ave Se, Puyallup, WA 98374 | 2009-07-08 |
| 1497921191 | Morgan Counseling Services Inc. | Substance Abuse Rehabilitation Facility | 10312 120th Street East, Suite #3, Puyallup, WA 98374 | 2008-05-02 |
| 1700055795 | Walter Royal Patterson Jr. | Registered Nurse | 11102 Sunrise Blvd. E., Ste. 103, Woodcreek Healthcare, Puyallup, WA 98374 | 2008-02-25 |
| Find all providers in zip 98374 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336621267 | Cara Tseng | Physician Assistant | 2940 S Meridian, Suite 200, Puyallup, WA 98373 | 2018-09-06 |
| 1265925911 | Erika A Euker | Physician Assistant | 3801 5th St Se Ste 110, Puyallup, WA 98374-2106 | 2018-06-07 |
| 1912446543 | Amber Keavey Huynh | Physician Assistant | 1450 5th St Se Ste 2100, Puyallup, WA 98372-4693 | 2017-02-15 |
| 1073056511 | Jordan Albano | Physician Assistant | 15214 Canyon Rd E Fl 1, Puyallup, WA 98375-7457 | 2016-12-01 |
| 1225468036 | Natalie Tajipour-glass | Physician Assistant | 11216 Sunrise Blvd. E. # 3-106, Puyallup, WA 98374-8848 | 2013-11-14 |
| 1043444300 | Sean Donohue | Physician Assistant | 1801 31st Ave Se, Puyallup, WA 98374-6320 | 2009-05-14 |
| 1245409911 | Jason S Hussey | Physician Assistant | 120 14th Ave Se Ste D, Puyallup, WA 98372 | 2008-02-26 |
| 1366582744 | Claudia May Devlin | Physician Assistant | 800 Meridian St S, Suite A, Puyallup, WA 98371-6995 | 2007-02-07 |
| 1396816682 | Consuelo Epistola | Physician Assistant | 800 S Meridian Ste A, Puyallup, WA 98371-6994 | 2006-11-10 |
| 1245331487 | Kevin S Lewis | Physician Assistant | 120 10th St Sw, Puyallup, WA 98371-5308 | 2006-09-26 |
| Find all providers in PUYALLUP | ||||
Please comment or provide details below to improve the information on MISS TRACIE MARIE JEFFERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.