Individual
KIM R PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS PA-C
Contact information
Practice address
501 SE 172ND AVE, VANCOUVER, WA 98684-9542
(360) 882-2778
(360) 604-1712
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10200
MN
363A00000X
Physician Assistant
Primary
PA60511027
WA
363AM0700X
Medical Physician Assistant
PA1356
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41952400
—
WI
Enumeration date
10/12/2006
Last updated
03/03/2015
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