Individual
KYLIE RAEANN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17707 W MAIN ST FL 1, MONROE, WA 98272-1967
(360) 282-3885
(360) 512-2026
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
(536) 816-6262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61482872
WA
Other
Enumeration date
08/15/2022
Last updated
09/04/2024
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