Provider Demographics
NPI:1437882982
Name:BOUNKEUA, PHILLIP (PA-C)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BOUNKEUA
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 1:13735B CORLLISS AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7260
Mailing Address - Country:US
Mailing Address - Phone:206-724-2512
Mailing Address - Fax:
Practice Address - Street 1:3909 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5134
Practice Address - Country:US
Practice Address - Phone:360-570-3462
Practice Address - Fax:360-339-7266
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61615168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant