Provider Demographics
NPI:1669848297
Name:SECORA, KARISSA A (PA)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:A
Last Name:SECORA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 6TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4682
Mailing Address - Country:US
Mailing Address - Phone:253-403-7277
Mailing Address - Fax:253-403-7213
Practice Address - Street 1:915 6TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4682
Practice Address - Country:US
Practice Address - Phone:253-403-7277
Practice Address - Fax:253-403-7213
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111354Medicaid