Individual
MR. KERRY L MAYHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1007 KOALA AVE, OMAK, WA 98841-9247
(509) 826-8443
Mailing address
25 HAUSSLER RD, OMAK, WA 98841-9591
(509) 826-6832
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001928
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003797
—
WA
01
—
127522
L&I
WA
Enumeration date
08/20/2006
Last updated
12/11/2007
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