Provider Demographics
NPI:1043250335
Name:HARRINGTON, JACKLYN HUTCHENS (PA C)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:HUTCHENS
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S 336TH STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDRAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:509-942-2159
Practice Address - Fax:509-942-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004867363AM0700X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8434821Medicaid
WA0203518OtherLIWA
WA3076HAOtherBSWA
WA0202689OtherLIWA
WA0202689OtherLIWA
WA0203518OtherLIWA
WAS64436Medicare UPIN