# ALAN K MIRLY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1891780524
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA-558 | ID | — |
| 363A00000X | Physician Assistant | PA60997082 | WA | Yes |

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 12/09/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2143194 | — | WA |
| 05 | — | 807225300 | — | ID |
| 01 | — | PAWV4 | BLUE CROSS | ID |