Provider Demographics
NPI:1124501630
Name:DICKENS, KESLI ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:KESLI
Middle Name:ANNE
Last Name:DICKENS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KESLI
Other - Middle Name:ANNE
Other - Last Name:BICKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 SW 7TH ST STE A205
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2983
Mailing Address - Country:US
Mailing Address - Phone:877-522-1275
Mailing Address - Fax:
Practice Address - Street 1:1702 TACOMA AVE S STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1700
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:833-888-7145
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK149515363A00000X
WAPA61395609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1704447Medicaid
AK149515OtherSTATE OF ALASKA