Provider Demographics
NPI:1013499110
Name:VAN EVERY, KELSEY ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:VAN EVERY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANNE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:34509 9TH AVE S STE 304
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8709
Mailing Address - Country:US
Mailing Address - Phone:253-939-1230
Mailing Address - Fax:360-874-5959
Practice Address - Street 1:34509 9TH AVE S STE 304
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8709
Practice Address - Country:US
Practice Address - Phone:253-939-1230
Practice Address - Fax:360-874-5959
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60826579363A00000X
WA60826579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2107549Medicaid