Provider Demographics
NPI:1063025260
Name:KENDALL, ERIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BUCHERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT, MA-P
Mailing Address - Street 1:12333 NE 130TH LN STE TAN 110
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7467
Mailing Address - Country:US
Mailing Address - Phone:425-285-0060
Mailing Address - Fax:
Practice Address - Street 1:EVERGREEN HEALTH OBSTETRICS & GYNECOLOGY CARE
Practice Address - Street 2:12333 NE 130TH LN. STE. 110
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-285-0060
Practice Address - Fax:425-285-0070
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPA61231801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program