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NPI Code Detail

MEDICARE: RANDOLPH WEBSTER KERLEE PA-S

MEDICARE: RANDOLPH WEBSTER KERLEE PA-S
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1457800104
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH WEBSTER KERLEE PA-S
Provider Business Mailing Address
First Line : 5936 BELTWAY LOOP SE
Second Line :
City : LACEY
State : WA
Zip : 98513-6208
Country : US
Telephone Number : 360-951-7270
Fax Number :
Provider Business Practice Location Address
First Line : 4311 11TH AVE NE STE 200
Second Line :
City : SEATTLE
State : WA
Zip : 98105-6367
Country : US
Telephone Number : 206-616-4001
Fax Number : 206-616-3889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2016
Last Update Date : 09/22/2016

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