Provider Demographics
NPI:1457099525
Name:KWAN, JESSIE NGA KWOK (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:NGA KWOK
Last Name:KWAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 SE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1321
Mailing Address - Country:US
Mailing Address - Phone:425-922-3602
Mailing Address - Fax:
Practice Address - Street 1:12504 SE 70TH ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1321
Practice Address - Country:US
Practice Address - Phone:425-922-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61300860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily