Provider Demographics
NPI:1003420795
Name:EVERSOLE, KAYLA MAE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MAE
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NE 139TH ST STE 245
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2316
Mailing Address - Country:US
Mailing Address - Phone:303-565-9630
Mailing Address - Fax:
Practice Address - Street 1:2121 NE 139TH ST STE 245
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:303-565-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61328609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical