Provider Demographics
NPI:1265477129
Name:LAFAVE, KEVIN R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:LAFAVE
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 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:34519 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6761
Practice Address - Country:US
Practice Address - Phone:253-838-9700
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2164NOOtherBSWA
WA0150557OtherLIWA
WA1594LAOtherBSWA
WA1913LAOtherBSWA
WA8348914Medicaid
WA0150556OtherLIWA
WA8348914Medicaid
WA0150556OtherLIWA
WAP23399Medicare UPIN
WAGAB19517Medicare PIN