Provider Demographics
NPI:1457596058
Name:BOWERS, MYCHELLE YVONNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MYCHELLE
Middle Name:YVONNE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8325 59TH STREET CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4058
Mailing Address - Country:US
Mailing Address - Phone:888-674-5871
Mailing Address - Fax:206-694-2291
Practice Address - Street 1:6811 S 204TH ST STE 280
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1352
Practice Address - Country:US
Practice Address - Phone:888-674-5871
Practice Address - Fax:206-694-2291
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOA60926504363A00000X
WA60055073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant