Healthcare Provider Details

I. General information

NPI: 1235134131
Provider Name (Legal Business Name): KIRK BELLON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19379 7TH AVE NE
POULSBO WA
98370-7504
US

IV. Provider business mailing address

19379 7TH AVE NE
POULSBO WA
98370-7504
US

V. Phone/Fax

Practice location:
  • Phone: 360-394-1000
  • Fax:
Mailing address:
  • Phone: 360-394-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10005227
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: