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General NPI Number Information
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NPI Number | 1215810064
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Entity Type | Individual
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Provider Name | SAMUEL DYLAN GILLESPIE PA
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 17700 SE 272ND ST STE 105
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City | KENT
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State | WA
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Zip | 98042-4951
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Country | US
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Telephone | 253-792-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 17700 SE 272ND ST STE 105
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City | COVINGTON
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State | WA
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Zip | 98042-4951
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1227641
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License Number State |
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