1265477129 NPI number — MR. KEVIN R LAFAVE PA-C

Table of content: MR. KEVIN R LAFAVE PA-C (NPI 1265477129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265477129 NPI number — MR. KEVIN R LAFAVE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFAVE
Provider First Name:
KEVIN
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265477129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 S 336TH ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-838-6180
Provider Business Mailing Address Fax Number:
253-838-6418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34519 9TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-9700
Provider Business Practice Location Address Fax Number:
253-838-6418
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA10004138 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2164NO . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0150557 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1594LA . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1913LA . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8348914 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150556 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com