Provider Demographics
NPI:1922162510
Name:KILE, ZACHARY A (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:KILE
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 1:801 SW 16TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2628
Mailing Address - Country:US
Mailing Address - Phone:206-538-6300
Mailing Address - Fax:
Practice Address - Street 1:801 SW 16TH ST STE 121
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2628
Practice Address - Country:US
Practice Address - Phone:206-538-6300
Practice Address - Fax:206-538-6301
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06828363A00000X
AK853363AM0700X
WAPA60859694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2112954Medicaid
AK264087748OtherSTATE OF ALASKA
TX219048002Medicaid