Provider Demographics
NPI:1326569898
Name:BECHLER, KELENA (PA)
Entity Type:Individual
Prefix:
First Name:KELENA
Middle Name:
Last Name:BECHLER
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 1:4755 FAUNTLEROY WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4647
Mailing Address - Country:US
Mailing Address - Phone:206-201-0551
Mailing Address - Fax:206-201-0552
Practice Address - Street 1:4755 FAUNTLEROY WAY SW STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4647
Practice Address - Country:US
Practice Address - Phone:206-201-0551
Practice Address - Fax:206-201-0552
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020922363A00000X
WAPA61374911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2256064Medicaid