PUYALLUP CHILDREN'S CLINIC, PLLC (NPI# 1841407285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841407285 |
| Entity Type | Organization |
| Organization Name | PUYALLUP CHILDREN'S CLINIC, PLLC |
| Practice Address |
1322 3rd St Se Ste #240 Puyallup WA 98372-3771 |
| Practice Telephone | 2538481572 |
| Practice Fax Number | 2538413719 |
| Mailing Telephone | 2538481572 |
| Mailing Fax Number | 2538413719 |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | TIMOTHY B JOLLEY (OWNER) |
| Authorized Official Telephone | 2538481572 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1322 3RD ST SE STE #240 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98372-3771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194723973 | Long D Vu | Anesthesiology | 1322 3rd St Se, Puyallup, WA 98372-3771 | 2005-07-14 |
| 1215499058 | Venita Lena Schandorf | Registered Nurse | 1322 3rd St Se, Puyallup, WA 98372-3771 | 2019-04-02 |
| 1548794613 | Aubrey Siegel | Family Medicine | 1322 3rd St Se, Suite 240, Puyallup, WA 98372-3771 | 2017-04-16 |
| 1396110185 | Rosemarie Cosgayon Cannell | Pharmacist | 1322 3rd St Se, Suite #020, Puyallup, WA 98372-3771 | 2015-12-06 |
| 1962898775 | James Pense | Family Medicine | 1322 3rd St Se, Suite 240, Puyallup, WA 98372-3771 | 2015-04-08 |
| 1083000855 | James Green | Family Medicine | 1322 3rd St Se, Suite 240, Puyallup, WA 98372 | 2015-04-08 |
| 1184062200 | Preethy Pankaj | Student in an Organized Health Care Education/Training Program | 1322 3rd St Se, Suite 240, Puyallup, WA 98372 | 2013-06-11 |
| 1003252966 | Richard Kline | Student in an Organized Health Care Education/Training Program | 1322 3rd St Se, Suite 240, Puyallup, WA 98372-3771 | 2013-05-20 |
| 1417216359 | Ryan Patrick Finn | Student in an Organized Health Care Education/Training Program | 1322 3rd St Se, Suite 240, Puyallup, WA 98372-3771 | 2012-05-13 |
| 1548526973 | Vivian Susan Lee | Emergency Medicine | 1322 3rd St Se, Suite 240, Puyallup, WA 98372-3771 | 2012-04-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371532 | Jeffrey Allen Zhan | Urology | Good Samaritan Medical Office Bldg 1450 5th St Se, Suite 2100- Urology Clinic, Puyallup, WA 98372 | 2019-11-21 |
| 1447811419 | Serenity Counseling & Consulting, LLC | Marriage & Family Therapist | 102 23rd St Se, Unit B, Puyallup, WA 98372 | 2019-06-21 |
| 1316401565 | Katherine Juarez Davidson | Nurse Practitioner | 325 E Pioneer # A145, Puyallup, WA 98372 | 2019-01-22 |
| 1679041404 | Cara Ann Lundin | Nurse Practitioner | 11926 43rd St Crt E, Edgewood, WA 98372 | 2018-11-09 |
| 1104392109 | Megan Black | Occupational Therapist | 40 29th St Ne, Puyallup, WA 98372 | 2018-10-17 |
| 1063919470 | Myriah Shekinah Olakpe | Occupational Therapist | 516 Se 23rd Ave, Puyallup, WA 98372 | 2018-04-11 |
| 1902330202 | Tyler Girdler | Student in an Organized Health Care Education/Training Program | 1322 3rd Street Se Suite 240, Puyallup, WA 98372 | 2017-04-13 |
| 1770039471 | Mahalakshmi Hariharan | Pharmacist | 2117 28th St Se, Puyallup, WA 98372 | 2016-09-01 |
| 1801241112 | Nawazish Ali | Internal Medicine | 401 15th Ave Se Multicare God Samartian Hopsital, Puyallup, WA 98372 | 2016-04-25 |
| 1932567559 | Denice L. Voss | Physical Therapist | 400 29th St. Ne, Puyallup, WA 98372 | 2016-02-10 |
| Find all providers in zip 98372 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720498280 | Rainier Pediatrics, Inc | Pediatrics | 12904 94th Ave E, Puyallup, WA 98373-5538 | 2014-05-05 |
| 1497962831 | Puyallup Valley Pediatric Associates, P.s. | Pediatrics | 1322 3rd St Se, Suite #240, Puyallup, WA 98372-3771 | 2007-05-16 |
| 1568527539 | Evergreen Children's Clinic, Pllc | Pediatrics | 1910 S Meridian, Suite A, Puyallup, WA 98371-7531 | 2006-12-27 |
| 1710965538 | Holly N Johnson | Pediatrics | 1706 Meridian S, Suite 120, Puyallup, WA 98371-7516 | 2006-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568675544 | Robert Michael Lehman | Pediatrics | 1545 Nw 57th St, #522, Seattle, WA 98107-5643 | 2007-05-07 |
| 1134343676 | Michael Donlan | Pediatrics | 7103 N Skyline Dr, Spokane, WA 99208-6717 | 2007-04-13 |
| 1508927062 | David Alan Springer | Pediatrics | 4005 Wallingford Ave N, Seattle, WA 98103-8218 | 2006-12-12 |
| 1730247073 | Mohinder Singh Badyal | Pediatrics | 32124 1st Ave S, Ste100, Federal Way, WA 98003-5761 | 2006-12-05 |
| 1396813218 | Penny Russell Tronolone | Pediatrics | Echo Glen Children's Center, 33010 Se 99th St, Snoqualmie, WA 98065 | 2006-11-30 |
| 1164508792 | Deborah J Ayars | Pediatrics | 1901 S Union Ave Ste B1010, Tacoma, WA 98405-1801 | 2006-10-27 |
| 1922027168 | Tania Milad Matta | Pediatrics | 3950 Keene Road, West Richland, WA 99353 | 2006-07-19 |
| 1629025333 | Public Hospital District #1 of King County | Pediatrics | 6920 Coal Creek Pkwy Se, Ste 12, Newcastle, WA 98059-3147 | 2006-05-28 |
| 1861468720 | Gina Suzanne Sucato | Pediatrics | 13451 Se 36th St, Bellevue, WA 98006-1475 | 2006-02-28 |
| 1083605778 | Daryl William Linnell | Pediatrics | 784 14th Ave, Longview, WA 98632-2315 | 2005-11-02 |
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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.