Individual
KEIRA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 18TH AVE S, SEATTLE, WA 98144-4317
(253) 833-7444
Mailing address
1701 18TH AVE S, SEATTLE, WA 98144-4317
(616) 206-4359
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA61041267
WA
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
N/A
—
Enumeration date
07/06/2018
Last updated
04/24/2020
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