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Individual
BRENT PATRICK KISH
Active
Individual
BRENT PATRICK KISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004056
WA
363AM0700X
Medical Physician Assistant
PA10004056
WA
363AS0400X
Surgical Physician Assistant
PA10004056
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010024
—
WA
01
—
186889
LABOR & INDUSTRIES
WA
01
—
8920KI
REGENCE BLUE SHIELD
—
01
—
P00235352
RAILROAD MEDICARE
—
Enumeration date
06/08/2006
Last updated
08/06/2025
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