MEDICARE: NICHOLE MCALLISTER 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	363A00000X	Physician Assistant	0010-03246	NC
2	363A00000X	Physician Assistant	PA60248549	WA

General Provider Information

NPI Number	:	1952678401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MCALLISTER PA-C

Provider Business Mailing Address
First Line	:	1608 N ROAD 44
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-2667
Country	:	US
Telephone Number	:	509-543-9280
Fax Number	:	509-545-6275

Provider Business Practice Location Address
First Line	:	1608 N ROAD 44
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-2667
Country	:	US
Telephone Number	:	509-543-9280
Fax Number	:	509-545-6275

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	10/04/2013

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Directions to “ NICHOLE MCALLISTER PA-C” Practice Location

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