Provider Demographics
NPI:1538176706
Name:PAULSON, KARI B (PA-C)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:B
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359735
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-341-4612
Mailing Address - Fax:206-341-4614
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359735
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-341-4612
Practice Address - Fax:206-341-4614
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004167363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8323727Medicaid
WA0166735OtherL&I PIN
WA04167UOtherREGENCE BLUE SHIELD PIN
WA5364PAOtherREGENCE BLUE SHIELD PIN
WAAB26502Medicare PIN
WA04167UOtherREGENCE BLUE SHIELD PIN