| Kent William Wallace, PA-C, ARNP | |
|
1321 Colby Ave, Medical Staff Office (pmg), Everett, WA 98201-1665 | |
| (425) 261-2000 | |
| Not Available |
| Full Name | Kent William Wallace |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Surgical |
| Location | 1321 Colby Ave, Everett, Washington |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770662835 | NPI | - | NPPES |
| 124775 | Other | WA | LABOR AND INDUSTRIES |
| WA6512 | Other | WA | REGENCE |
| 8803430 | Other | WA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AS0400X | Physician Assistant - Surgical | PA10000442 (Washington) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Kent William Wallace, PA-C, ARNP Po Box 3360, Providence Health & Services, Portland, OR 97208-3360 Ph: (866) 366-2983 | Kent William Wallace, PA-C, ARNP 1321 Colby Ave, Medical Staff Office (pmg), Everett, WA 98201-1665 Ph: (425) 261-2000 |
Mr. James Potocsnak, PAC Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2320 Rucker Ave, Everett, WA 98201 Phone: 425-259-5121 Fax: 425-252-1322 | |
Michael James Oliver, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 3726 Broadway Ste 201, Everett, WA 98201 Phone: 425-317-9119 | |
Karen M Tooley, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1330 Rockefeller Ave, Suite 400, Everett, WA 98201 Phone: 425-261-4950 | |
Mary E Mitchell, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 3927 Rucker Ave, Everett, WA 98201 Phone: 425-339-5422 Fax: 425-303-3053 | |
Gary K. Baal, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1321 Colby Ave, Everett, WA 98201 Phone: 425-261-2000 | |
Travis B. Adelman, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 4201 Rucker Ave, Everett, WA 98203 Phone: 425-382-4000 | |
Ms. Jodi Stickler-ivie, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1321 Colby Ave, Everett, WA 98201 Phone: 425-261-2000 |