Provider Demographics
NPI:1891811311
Name:STONEKING, LILLIAN S (PA-C)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:S
Last Name:STONEKING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:S
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2727
Practice Address - Fax:360-474-2739
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00332363A00000X, 363AM0700X
WAPA10005191363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0222576OtherLABOR & INDUSTRIES
WA8486128Medicaid
WA8944962OtherCRIME VICTIMS
WA8866886Medicare PIN
WA8486128Medicaid