Provider Demographics
NPI:1578656047
Name:SHAPLEY, MARCY A (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:A
Last Name:SHAPLEY
Suffix:
Gender:F
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 1:2116 E SECTION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9124
Mailing Address - Country:US
Mailing Address - Phone:360-428-1700
Mailing Address - Fax:
Practice Address - Street 1:2116 E SECTION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9124
Practice Address - Country:US
Practice Address - Phone:360-428-1700
Practice Address - Fax:360-848-4350
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA10003789207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8363640Medicaid
WA172515OtherWORKMANS COMP
WA2252SHOtherREGENCE BLUE SHIELD 2ND
WA3642SHOtherREGENCE BLUE SHIELD
WA2252SHOtherREGENCE BLUE SHIELD 2ND
WAGAB39389Medicare ID - Type Unspecified