Individual
MARY KELLEY MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-XC
Contact information
Practice address
201 16TH AVE E, SEATTLE, WA 98112-5226
(206) 326-3000
Mailing address
201 16TH AVE E, SEATTLE, WA 98112-5226
(206) 326-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
504
MT
363A00000X
Physician Assistant
Primary
PA60471575
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038846
—
WA
01
—
504
LICENSE
MT
01
—
PA 9106243
LICENSE
FL
Enumeration date
03/21/2008
Last updated
04/27/2021
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