MEDICARE: ATHALIA L CLOWER PA-C

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10003094	WA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	319211600	OTHER	WA	GROUP MEDICARE PIN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1053349043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHALIA L CLOWER PA-C

Provider Business Mailing Address
First Line	:	945 GOETHALS DR
Second Line	:	STE 200
City	:	RICHLAND
State	:	WA
Zip	:	99352-3552
Country	:	US
Telephone Number	:	509-942-6327
Fax Number	:	509-946-0908

Provider Business Practice Location Address
First Line	:	3950 KEENE RD
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353-4901
Country	:	US
Telephone Number	:	509-942-3130
Fax Number	:	509-628-8335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/01/2021

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

3950 KEENE RD
WEST RICHLAND, WA
99353-4901