MEDICARE: KIRK JARMAN P.A.

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	363AM0700X	Medical Physician Assistant	PA16431	CA
2	363AS0400X	Surgical Physician Assistant	PA10004277	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1588658124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK JARMAN P.A.

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0368
Country	:	US
Telephone Number	:	360-491-8439
Fax Number	:	360-491-6328

Provider Business Practice Location Address
First Line	:	1625 MOTTMAN RD SW
Second Line	:	SUITE A
City	:	TUMWATER
State	:	WA
Zip	:	98512-7833
Country	:	US
Telephone Number	:	360-528-2822
Fax Number	:	360-528-2830

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/11/2008

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