Provider Demographics
NPI:1134102312
Name:PRICE, STEPHEN WALLINGFORD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WALLINGFORD
Last Name:PRICE
Suffix:
Gender:M
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 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:11521 NE 128TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4317
Practice Address - Country:US
Practice Address - Phone:425-899-6800
Practice Address - Fax:425-899-6808
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA127276OtherLABOR & INDUSTRIES
WA8323016Medicaid
WAP00163315OtherMEDICARE RAILROAD
WA8323016Medicaid
WAP00163315OtherMEDICARE RAILROAD