Provider Demographics
NPI:1588658124
Name:JARMAN, KIRK (PA)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:JARMAN
Suffix:
Gender:M
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0368
Mailing Address - Country:US
Mailing Address - Phone:360-491-8439
Mailing Address - Fax:360-491-6328
Practice Address - Street 1:1625 MOTTMAN RD SW
Practice Address - Street 2:SUITE A
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7833
Practice Address - Country:US
Practice Address - Phone:360-528-2822
Practice Address - Fax:360-528-2830
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16431363AM0700X
WAPA10004277363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8466252Medicaid
WA8466252Medicaid
WA8861918Medicare PIN