MEDICARE: MEDINA KHADIJA OTHMAN GLENN PA

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	363A00000X	Physician Assistant	PA70040194	WA

General Provider Information

NPI Number	:	1841168507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEDINA KHADIJA OTHMAN GLENN PA

Provider Business Mailing Address
First Line	:	PO BOX 1668
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-5001
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N 13TH ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2077
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:

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

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	01/21/2026

Similar Medicare Providers

1205715216 — ASTIANA MARIE STULTS PA-C
Practice Location Address:

1701 N 13TH ST
SHELTON, WA
98584-2077

Practice Phone: 360-432-3298
Practice Fax:

1942209044 — DR. MONICA B VUONG MD
Practice Location Address:

1701 N 13TH ST
SHELTON, WA
98584-2077

Practice Phone: 360-426-2653
Practice Fax:

1669468351 — DR. ALLEN MILLARD III MD
Practice Location Address:

1701 N 13TH ST
SHELTON, WA
98584-2077

Practice Phone: 360-426-2653
Practice Fax:

1619964186 — MISS RESA SHANER PA-C
Practice Location Address:

1701 N 13TH ST STE 100
SHELTON, WA
98584-2077

Practice Phone: 360-426-2653
Practice Fax: 360-427-7086

1124056437 — MR. CHARLES W ANDEREGG PAC
Practice Location Address:

1701 N 13TH ST STE A
SHELTON, WA
98584-2077

Practice Phone: 360-426-2653
Practice Fax:

1992813679 — JESS CALOHAN DNP, PMHNP-BC, FAAN
Practice Location Address:

1701 N 13TH ST
SHELTON, WA
98584-2077

Practice Phone: 360-358-3690
Practice Fax:

Directions to “ MEDINA KHADIJA OTHMAN GLENN PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.