Provider Demographics
NPI:1922181304
Name:KNOWLES, JENNIFER T (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 3RD ST SE STE 240
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3771
Mailing Address - Country:US
Mailing Address - Phone:253-697-5757
Mailing Address - Fax:
Practice Address - Street 1:1322 3RD ST SE STE 240
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8156523Medicaid
WA4543880OtherAETNA PROVIDER ID
WAP00297686OtherMEDICAID RAILROAD
WA8906802OtherL&I CVC
WA0199801OtherL&I
WA3908KNOtherREGENCE RIDER
WA0199801OtherL&I
WAP00297686OtherMEDICAID RAILROAD