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Individual

MR. GUILLERMO VALES KENNEDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1500 CONTINENTAL PL, MOUNT VERNON, WA 98273
(360) 424-7041
(360) 424-2418
Mailing address
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 424-7041

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
363AS0400X
Surgical Physician Assistant
Primary
PA60912831
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2137460
WA
Enumeration date
05/28/2019
Last updated
06/02/2022
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