Individual
ANGELA DIANE KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109-4405
(206) 288-1000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12458139-1206
UT
363AM0700X
Medical Physician Assistant
PA03137
TX
363AM0700X
Medical Physician Assistant
PA60302788
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144289265
—
WA
05
—
135814505
—
TX
Enumeration date
03/18/2006
Last updated
12/20/2021
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