Provider Demographics
NPI:1629192075
Name:PAYETTE CLINICS, PC
Entity Type:Organization
Organization Name:PAYETTE CLINICS, PC
Other - Org Name:PAYETTE CLINIC MEDICAL & MENTAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARTENE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:360-216-4493
Mailing Address - Street 1:4210 NE 66TH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-216-4493
Mailing Address - Fax:360-993-1800
Practice Address - Street 1:4210 NE 66TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-216-4493
Practice Address - Fax:360-993-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645193Medicaid
WA8854375Medicare ID - Type Unspecified