Individual
KELLIE CHRISTINE HERGENRADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
915 SHERIDAN ST, PORT TOWNSEND, WA 98368-2931
(360) 385-4848
Mailing address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61479777
WA
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/01/2022
Last updated
04/16/2024
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