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Kent William Wallace, PA-C,ARNP
Surgical Physician Assistant in Everett, Washington
NPI 1770662835

Kent William Wallace is a Surgical Physician Assistant based in Portland, WA and is specialized in Surgical. Kent William Wallace practices in Everett, WA and has the professional credentials of PA-C,ARNP. The NPI Number for Kent William Wallace is 1770662835 and holds a License No. PA10000442 (Washington).

The current practice location address for Kent William Wallace is 1321 Colby Ave, Everett, WA and can be reached out via phone at 425-261-2000.

Location: 1321 Colby Ave, Everett, WA, 97208-3360
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Provider Profile Details
NPI Number
1770662835
Provider Name
Kent William Wallace
Credential
PA-C,ARNP
Provider Entity Type
Individual
Gender
Male
Address
1321 Colby Ave, Everett, WA, 97208-3360
Phone Number
425-261-2000
Fax Number
Provider Enumeration Date
11/02/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
124775 01 WA LABOR AND INDUSTRIES
WA6512 01 WA REGENCE
8803430 01 WA RAILROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
1321 Colby Ave
City
State
Zip
98201-1665
Phone Number
425-261-2000
Fax Number
person
Provider Business Mailing Address Details
Address
1321 Colby Ave
City
State
Zip
98201-1665
Phone Number
425-261-2000
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
PA10000442 (Washington)
Definition
Definition to come...
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