Healthcare Provider Details

I. General information

NPI: 1336618040
Provider Name (Legal Business Name): BAILEY BANGERTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 RAINIER AVE S
SEATTLE WA
98118-2398
US

IV. Provider business mailing address

5316 RAINIER AVE S
SEATTLE WA
98118-2398
US

V. Phone/Fax

Practice location:
  • Phone: 206-721-5600
  • Fax: 206-326-3825
Mailing address:
  • Phone: 206-721-5600
  • Fax: 206-326-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.PA.60900605
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: