Individual
KYLE D MAHAFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11411 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3047
(253) 581-9002
Mailing address
5111 76TH AVENUE CT W, UNIVERSITY PLACE, WA 98467-4597
(360) 224-4665
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60696945
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2069443
—
WA
Enumeration date
03/03/2015
Last updated
05/10/2019
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