Individual
MATHEW KUMMERFELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1701 N 13TH ST, SHELTON, WA 98584-2077
(360) 426-2653
(888) 985-0681
Mailing address
PO BOX 1668, SHELTON, WA 98584-5001
(360) 426-2653
(888) 985-0681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0228031
STATE L&I
WA
01
—
0273939
L&I
WA
01
—
0275126
L&I
WA
01
—
0275142
L&I
WA
05
—
8502049
—
WA
01
—
8946032
STATE CRIME VICTIMS
WA
01
—
P00610661
RAILROAD
WA
Enumeration date
12/18/2007
Last updated
02/21/2024
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