Healthcare Provider Details

I. General information

NPI: 1821403320
Provider Name (Legal Business Name): PRECIOUS ALEXANDRA RAVINA STONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX STONE PA-C

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOETHALS DR STE B
RICHLAND WA
99352-3301
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3080
  • Fax: 509-942-3085
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60482792
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003312
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056920
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA60492900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: