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KENT WILLIAM WALLACE PA-C ARNP NPI 1770662835


NPI Information

NPI: 1770662835
Provider Name: KENT WILLIAM WALLACE, PA-C, ARNP
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Address:
1321 COLBY AVE
MEDICAL STAFF OFFICE (PMG)
EVERETT, WA
ZIP 98201
Phone: (425) 261-2000
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Kent William Wallace, PA-C, ARNP is a surgical physician assistant in Everett, WA. Kent William Wallace, PA-C, ARNP NPI is 1770662835. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1321 COLBY AVE
MEDICAL STAFF OFFICE (PMG)
EVERETT, WA
ZIP 98201-665
Phone: (425) 261-2000

The enumeration date for this NPI number is 11/2/2006 and was last updated on 2/6/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363AS0400XPhysician AssistantSurgicalPA10000442WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
18803430OTHERWASHINGTONRAILROAD MEDICARE
2R30054MEDICARE UPINWASHINGTON
3124775OTHERWASHINGTONLABOR AND INDUSTRIES
491-1682959OTHERWASHINGTONTIN
5WA6512OTHERWASHINGTONREGENCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.