Healthcare Provider Details

I. General information

NPI: 1083788483
Provider Name (Legal Business Name): ANGELA M KLINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 SE TECH CENTER PL STE 190
VANCOUVER WA
98683-5529
US

IV. Provider business mailing address

16420 SE MCGILLIVRAY BLVD STE 103
VANCOUVER WA
98683-3599
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-7802
  • Fax: 360-326-2606
Mailing address:
  • Phone: 360-828-7802
  • Fax: 360-326-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number70111806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: