Provider Demographics
NPI:1962826479
Name:KASNICK, SARAH JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:KASNICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:BRAINERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 RAMSAY WAY STE 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4544
Practice Address - Country:US
Practice Address - Phone:253-372-7960
Practice Address - Fax:253-372-7965
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04732363A00000X
ORPA180488363A00000X
WAPA61068955363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant