Organization
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Active
Other names
Walla Walla Clinic (Professional)
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN MICHELSON (CEO)
(509) 525-3720
Entity
Organization
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1592
Mailing address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1592
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208199
—
OR
01
—
30200
L&I
WA
05
—
7809205
—
WA
Enumeration date
02/17/2006
Last updated
12/23/2025
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