Provider Demographics
NPI:1881774859
Name:SCOTT-VESSEL, BRANDEA J (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDEA
Middle Name:J
Last Name:SCOTT-VESSEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:425-297-5561
Practice Address - Street 1:1717 13TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-258-3900
Practice Address - Fax:425-297-5561
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039567OtherINTERNAL ID-MOTOR VEHICLE ID
WA8439119Medicaid
WA0271925OtherLABOR AND INDUSTRY
8856320Medicare ID - Type Unspecified
WA8896470Medicare PIN
Q32253Medicare UPIN