KENT WILLIAM WALLACE (NPI# 1770662835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770662835 |
Entity Type | Individual |
Full Name | KENT WILLIAM WALLACE |
Credential | PA-C, ARNP |
Practice Address |
1321 Colby Ave Medical Staff Office (pmg) Everett WA 98201-1665 |
Mailing Address |
Po Box 3360 Providence Health & Services Portland OR 97208-3360 |
Practice Telephone | 4252612000 |
Mailing Telephone | 8663662983 |
Enumeration Date | 2006-11-02 |
Last Update Date | 2015-02-06 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA10000442 | WA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | LABOR AND INDUSTRIES | 124775 | 01 |
WA | REGENCE | WA6512 | 01 |
WA | RAILROAD MEDICARE | 8803430 | 01 |
Street Address |
1321 COLBY AVE MEDICAL STAFF OFFICE (PMG) |
City | EVERETT |
State | WA |
Zip Code | 98201-1665 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073519328 | Albert Dominick Pacifico II | Internal Medicine | 1321 Colby Ave, Medical Staff Office, Everett, WA 98201-1665 | 2005-06-22 |
1083239610 | Arianna Randolph | Social Worker | 1321 Colby Ave, Everett, WA 98201-1665 | 2020-06-09 |
1619527595 | Katherine Doreen Carpenter | Pharmacy Technician | 1321 Colby Ave, C-wing First Floor, Everett, WA 98201 | 2019-09-12 |
1396302477 | Ashley L Grieve | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2019-05-23 |
1588140073 | Naa Afadua Annoh | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2018-07-17 |
1386170694 | Katherine Mccusker | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2017-05-05 |
1437602935 | Rebecca Louise Formosa | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-08-01 |
1144673153 | Julie Editha Quandt | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-07-14 |
1013361518 | Rhadika Mccormick Souza | Emergency Medicine | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-04-20 |
1013379114 | Katherine Morgan | Internal Medicine | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-03-28 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
Find all providers in zip 98201 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295822740 | Gregory Douglas Stewart Sr. | Physician Assistant | 2424 122nd St Sw, B, Everett, WA 98204-4744 | 2006-10-06 |
1003881020 | James Potocsnak | Physician Assistant | 2320 Rucker Ave, Everett, WA 98201 | 2006-02-22 |
1710979521 | Eric M Tilley | Physician Assistant | 728 134th St Sw Ste 120, Radia Inc., Ps, Everett, WA 98204-5322 | 2005-08-17 |
1003271339 | Christine Reichert | Physician Assistant | 1330 Rockefeller Ave Ste 400, Everett, WA 98201-1676 | 2015-12-31 |
1396132015 | Alvin Abueg | Physician Assistant | 3927 Rucker Ave, Everett, WA 98201-4833 | 2015-04-21 |
1598167074 | Jon Pennington | Physician Assistant | 3726 Broadway, Suite 201, Everett, WA 98201-3787 | 2014-09-16 |
1528496858 | James Albert Marsh | Physician Assistant | 3927 Rucker Ave, Everett, WA 98201-4833 | 2013-10-23 |
1558609578 | Julie Lorraine Patterson | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2013-01-25 |
1871809517 | Amanda Farrell | Physician Assistant | 103 Garland St, Everett, MA 02149 | 2010-08-19 |
1528370723 | Western Washington Medical Group, Inc | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2010-07-06 |
Find all providers in EVERETT |
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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.