Provider Demographics
NPI: | 1023005543 |
---|---|
Name: | MCCORKINDALE, ESTHER Y (PAC) |
Entity Type: | Individual |
Prefix: | |
First Name: | ESTHER |
Middle Name: | Y |
Last Name: | MCCORKINDALE |
Suffix: | |
Gender: | F |
Credentials: | PAC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2500 RACQUET LN |
Mailing Address - Street 2: | STE 100 |
Mailing Address - City: | YAKIMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98902-6114 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-249-3900 |
Mailing Address - Fax: | 509-573-9539 |
Practice Address - Street 1: | 2500 RACQUET LN |
Practice Address - Street 2: | STE 100 |
Practice Address - City: | YAKIMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98902-6114 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-249-3900 |
Practice Address - Fax: | 509-573-9539 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-29 |
Last Update Date: | 2016-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 025211PA10004017 | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 8357493 | Medicaid | |
WA | 970021921 | Other | RAILROAD MEDICARE PIN |
WA | 8357493 | Medicaid | |
WA | GAB16165 | Medicare PIN | |
WA | GAB16166 | Medicare PIN |