Provider Demographics
NPI:1073031761
Name:KLOTH, STEPHANIE (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KLOTH
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:FRANKLIN PARK MEDICAL BUILDING 220 EAST ROWAN
Mailing Address - Street 2:#300
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207
Mailing Address - Country:US
Mailing Address - Phone:509-489-3554
Mailing Address - Fax:
Practice Address - Street 1:220 E ROWAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1203
Practice Address - Country:US
Practice Address - Phone:509-489-3554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60922980363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical