Individual
KERRY A MICHAELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
840 S MEYERS ST, KETTLE FALLS, WA 99141-7005
(509) 685-7848
(509) 684-5817
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 944-9644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004334
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
294110
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8014474
—
WA
Enumeration date
10/27/2006
Last updated
06/18/2021
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