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General NPI Number Information
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NPI Number | 1336800168
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Entity Type | Individual
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Provider Name | KASSIDY NOELLE BRUGMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 101 NW 12TH AVE STE 107
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City | BATTLE GROUND
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State | WA
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Zip | 98604-9141
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Country | US
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Telephone | 360-723-0528
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Fax |
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Provider Business Mailing Address
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Address Line | 9704 NE 150TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-2779
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Country | US
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Telephone | 360-608-7578
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NC60791384
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.PA.61689173
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | PC61239792
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License Number State | WA
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