MR. KENNETH LEO FLECK (NPI# 1417045857) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417045857 |
| Entity Type | Individual |
| Full Name | MR. KENNETH LEO FLECK |
| Credential | PA-C |
| Practice Address |
910 Tacoma Ave S Tacoma WA 98402-2104 |
| Mailing Address |
5012 161st St E Tacoma WA 98446-3810 |
| Practice Telephone | 2537084033 |
| Practice Fax Number | 2537984043 |
| Mailing Telephone | 2535361232 |
| Mailing Fax Number | 2535369028 |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10001613 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | GAB36263 | 05 |
| Street Address |
910 TACOMA AVE S |
| City | TACOMA |
| State | WA |
| Zip Code | 98402-2104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013231695 | Pierce County Jail Clinic | Physician Assistant | 910 Tacoma Ave S, Tacoma, WA 98402-2104 | 2010-03-25 |
| 1699828103 | P.c. Jail Clinic | Custodial Care Facility | 910 Tacoma Ave S, Tacoma, WA 98402-2104 | 2007-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548898638 | Cimberleigh Mclean | Social Worker | 2367 Tacoma Ave S Ofc 211, Tacoma, WA 98402 | 2020-04-01 |
| 1831735802 | Nickolas Justin Wise | Case Manager/Care Coordinator | 1159 Market St, Tacoma, WA 98402 | 2019-11-25 |
| 1841835436 | Michael Roy Bolden | Counselor | 1205 Tacoma Ave S., Suite 1205, Tacoma, WA 98402 | 2019-11-07 |
| 1073024980 | Megan Elizabeth Charron Mourfield | Denturist | 725 St Helens Ave S, Tacoma, WA 98402 | 2017-10-18 |
| 1104367937 | Janelle Santiago | Counselor | Mcdonald Smith Building 110, Uw Autism Center Tacoma, Tacoma, WA 98402 | 2017-03-13 |
| 1891167862 | Tanya Larson Therapy | Community/Behavioral Health | 1102 A. St., Suite 109, (suite 109), Tacoma, WA 98402 | 2015-10-29 |
| 1609242148 | Ashley Lorraine Dahlgren | Peer Specialist | 702 S 14th St., Tacoma, WA 98402 | 2015-08-19 |
| 1821416470 | Nicole Villarreal Mccormick | Acupuncturist | 711 A Ct #100, Tacoma, WA 98402 | 2014-04-01 |
| 1184055824 | Robyn Marie Callahan | Social Worker | 1102 A Street, Suite 202 B, Tacoma, WA 98402 | 2013-12-05 |
| 1679909410 | Kristin Sweet Fischer | Counselor | 708 Market St Unit 411, Tacoma, WA 98402 | 2013-09-25 |
| Find all providers in zip 98402 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407300098 | Joshua David Evans | Physician Assistant | 9040 Jackson Ave Mchj Clq C, Tacoma, WA 98431-1100 | 2016-08-11 |
| 1790177731 | Taylor Marquardt | Physician Assistant | 1624 S I St Ste 305, Tacoma, WA 98405-5093 | 2015-02-27 |
| 1134540909 | Otis Lawrence | Physician Assistant | 608 E 62nd St, Tacoma, WA 98404-1935 | 2013-12-22 |
| 1689905788 | Jason F Naylor | Physician Assistant | 9040 Jackson Avenu, Tacoma, WA 98431-7037 | 2010-01-29 |
| 1952536146 | Eric Vangsnes | Physician Assistant | 9040 Reid St., Attn: Mchj-qcr, Tacoma, WA 98431-1100 | 2009-05-18 |
| 1801048731 | Anthony Cee Charles | Physician Assistant | 1307 Martin Luther King Jr Way, Tacoma, WA 98405-3929 | 2008-10-22 |
| 1083742480 | Darin W Smith | Physician Assistant | 1623 E J St, Tacoma, WA 98421-1602 | 2007-02-28 |
| 1912924366 | Marthe Butzen | Physician Assistant | 1708 E. 44th Street, Tacoma, WA 98404 | 2006-07-15 |
| 1013973205 | Sheldon Burdell Watson | Physician Assistant | Madigan Army Medical Center/okubo Clinic, 9040 Jackson Ave, Tacoma, WA 98431-1730 | 2006-04-25 |
| 1851351522 | Craig Philip Wallace | Physician Assistant | Va Puget Sound, American Lake Division, Tacoma, WA 98493-0001 | 2006-03-25 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.