Provider Demographics
NPI:1093802373
Name:HERNANDEZ, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 TORBETT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2667
Mailing Address - Country:US
Mailing Address - Phone:509-427-1450
Mailing Address - Fax:509-420-4224
Practice Address - Street 1:217 TORBETT ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2667
Practice Address - Country:US
Practice Address - Phone:509-427-1450
Practice Address - Fax:509-420-4224
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003590363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16232OtherL&I
WAMH0287284OtherDEA