Provider Demographics
NPI:1609834027
Name:FINNIGAN, KEVIN BERNARD (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BERNARD
Last Name:FINNIGAN
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 1:17926 69TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2474
Mailing Address - Country:US
Mailing Address - Phone:253-303-1052
Mailing Address - Fax:
Practice Address - Street 1:17926 69TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2474
Practice Address - Country:US
Practice Address - Phone:253-303-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ69884Medicare UPIN