MEDICARE: SARAH KISH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MA061117	PA
2	207Q00000X	Family Medicine Physician	PA61090865	WA
3	390200000X	Student in an Organized Health Care Education/Training Program		WA
4	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	PA61090865	WA

General Provider Information

NPI Number	:	1891268884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KISH PA-C

Provider Business Mailing Address
First Line	:	805 MADISON ST STE 401
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-1172
Country	:	US
Telephone Number	:	206-467-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 BROADWAY E STE 10
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-5023
Country	:	US
Telephone Number	:	503-684-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	12/09/2022

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Directions to “ SARAH KISH PA-C” Practice Location

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