Provider Demographics
NPI:1033264056
Name:TREECE, KRISTIN MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:TREECE
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:212 E CENTRAL AVE STE 245
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-252-1977
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004228363AS0400X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA23161OtherE WA GROUP HEALTH
WA8360323Medicaid
WA970021842Medicare PIN
WAP41591Medicare UPIN
WAAB24766Medicare ID - Type Unspecified