Provider Demographics
NPI:1023193828
Name:EMERY, KIM IRENE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:IRENE
Last Name:EMERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1012 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1012 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:253-333-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
273OtherINTERNAL ID-MOTOR VEHICLE ID
WA8356487Medicaid
WA8356487Medicaid
AB36548Medicare ID - Type Unspecified