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Individual

KALI MARIE THIBAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
11311 BRIDGEPORT WAY SW STE 309, LAKEWOOD, WA 98499-3078
(253) 985-2949
(253) 985-2948
Mailing address
11311 BRIDGEPORT WAY SW STE 309, LAKEWOOD, WA 98499-3078
(253) 985-2949
(253) 985-2948

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61073932
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2165926
WA
Enumeration date
07/24/2020
Last updated
12/18/2020
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