Provider Demographics
NPI:1215403100
Name:RISLEY, ALLISON DIANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:DIANNE
Last Name:RISLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:DIANNE
Other - Last Name:RISLEY KERSTIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3131 E MADISON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4266
Mailing Address - Country:US
Mailing Address - Phone:206-462-5850
Mailing Address - Fax:
Practice Address - Street 1:3131 E MADISON ST STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4266
Practice Address - Country:US
Practice Address - Phone:206-462-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61334724363A00000X
CAPA56117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant