| Familycare Of Kent | |
|
10024 Se 240th St Suite 201 Kent WA 98031-5124 | |
| (253) 859-2273 | |
| (253) 850-8894 |
| Full Name | Familycare Of Kent |
|---|---|
| Speciality | Clinic/Center |
| Location | 10024 Se 240th St, Kent, Washington |
| Authorized Official Name and Position | Madeline D Wiley (OWNER/MANAGER) |
| Authorized Official Contact | 2538592273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Familycare Of Kent 10024 Se 240th St Suite 201 Kent WA 98031-5124 Ph: (253) 859-2273 | Familycare Of Kent 10024 Se 240th St Suite 201 Kent WA 98031-5124 Ph: (253) 859-2273 |
| NPI Number | 1821276759 |
|---|---|
| Provider Enumeration Date | 02/01/2008 |
| Last Update Date | 07/22/2022 |
| Medicare PECOS PAC ID | 5799707337 |
|---|---|
| Medicare Enrollment ID | O20051227000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821276759 | NPI | - | NPPES |
| 9626888 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | AP30001318 (Washington) | Primary |
| Provider Name | Shawna O Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053307926 PECOS PAC ID: 3779538632 Enrollment ID: I20050314001045 |
| Provider Name | Robert T Smithing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023004611 PECOS PAC ID: 2769407733 Enrollment ID: I20051008000204 |
| Provider Name | Madeline D Wiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932195526 PECOS PAC ID: 9931124906 Enrollment ID: I20051008000209 |
| Provider Name | Vanessa Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811410442 PECOS PAC ID: 2365716578 Enrollment ID: I20170926003039 |
| Provider Name | Spencer H. Rizk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770076101 PECOS PAC ID: 1850640186 Enrollment ID: I20200513000519 |
| Provider Name | Kristin Ann Burns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609401686 PECOS PAC ID: 8224469853 Enrollment ID: I20200514000239 |
| Provider Name | Coreen Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710584099 PECOS PAC ID: 2860804804 Enrollment ID: I20201215002207 |
| Provider Name | Faith Rachelle Agduyeng Sairez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134882467 PECOS PAC ID: 1153712708 Enrollment ID: I20211215002695 |
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