Provider Demographics
NPI:1184393456
Name:KEMPTON, SELINA DANIELLE (PAC)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:DANIELLE
Last Name:KEMPTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 NW ANDERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6807
Mailing Address - Country:US
Mailing Address - Phone:360-698-6630
Mailing Address - Fax:360-698-7002
Practice Address - Street 1:4409 NW ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6807
Practice Address - Country:US
Practice Address - Phone:360-698-6630
Practice Address - Fax:360-698-7002
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61352492363AS0400X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2232061Medicaid