Individual
KENT WILLIAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ARNP
Contact information
Practice address
1321 COLBY AVE, MEDICAL STAFF OFFICE (PMG), EVERETT, WA 98201-1665
(425) 261-2000
Mailing address
PO BOX 3360, PROVIDENCE HEALTH & SERVICES, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10000442
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124775
LABOR AND INDUSTRIES
WA
01
—
8803430
RAILROAD MEDICARE
WA
01
—
WA6512
REGENCE
WA
Enumeration date
11/02/2006
Last updated
02/06/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us