Provider Demographics
NPI:1891755989
Name:COLE-VADJIC, KELLI KRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:KRISTINE
Last Name:COLE-VADJIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:KRISTINE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-788-8222
Mailing Address - Fax:360-788-7759
Practice Address - Street 1:3301 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1919
Practice Address - Country:US
Practice Address - Phone:360-788-8222
Practice Address - Fax:360-788-7759
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8469983Medicaid