Provider / Organization | NPI | Date Certified |
---|---|---|
KALI MARIE THIBAULT | 1336758432 | 2020-12-18 |
Kali Marie Thibault [F] graduated in 2020 and primarily specializes in Physician Assistant.
Kali Marie Thibault is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1336758432. Registration indicates Kali Marie Thibault is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
PECOS ID | 3971929886 |
Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
Entity Type | Individual |
Provider Name | Kali Marie Thibault PHYSICIAN ASSISTANT |
Practice Office Address | 11311 BRIDGEPORT WAY SW STE 309 LAKEWOOD, WA US |
Practice Office Telephone | 2539852949 |
Practice Office Fax | 2539852948 |
Mailing Address | 11311 BRIDGEPORT WAY SW STE 309 LAKEWOOD, WA 984993078 US |
Business Telephone | 2539852949 |
Business Fax | 2539852948 |
Direct Messaging Address [] | [email protected] | Direct Franciscan Medical Group |
Code | Practice | License No State |
---|---|---|
363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA61073932
WA |
2165926 | MEDICAID | WA |