MEDICARE: PATRICIA L LIGHTFOOT PA-C

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
1	363AS0400X	Surgical Physician Assistant	PA10004496	WA
2	363A00000X	Physician Assistant	PA10004496	WA

General Provider Information

NPI Number	:	1528088952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L LIGHTFOOT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S MCCLELLAN ST STE 118
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-2446
Country	:	US
Telephone Number	:	509-838-7100
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/06/2023

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