Provider Demographics
NPI:1023392529
Name:MATTERN, KRISTIE MICHELLE (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:MATTERN
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 1:7902 27TH ST W STE 7A
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3431
Mailing Address - Country:US
Mailing Address - Phone:253-346-8859
Mailing Address - Fax:
Practice Address - Street 1:7902 27TH ST W STE 7A
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3431
Practice Address - Country:US
Practice Address - Phone:253-500-4059
Practice Address - Fax:253-503-7977
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003450363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical