Provider Demographics
NPI:1942536321
Name:ADI, NADIMA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NADIMA
Middle Name:
Last Name:ADI
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 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:7350 W DESCHUTES AVE STE B103
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7802
Practice Address - Country:US
Practice Address - Phone:509-737-3371
Practice Address - Fax:509-736-0958
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120212363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500628169Medicaid
WA9329810OtherAETNA
WAG8966886OtherMEDICARE
WA0266055OtherLABOR & INDUSTRIES
WA6639748OtherCIGNA
WA1942536321Medicaid
WA1942536321Medicaid