Basic Information
| Provider Information | |||||||||
| NPI: | 1972086692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAREY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 BROADWAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984023400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534031000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 704 TROSPER RD SW STE 118 | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985127072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607637050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2018 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | PA60996713 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.