Active NPI
Mekko Kamara Gillen, PA-C
- Medical Physician Assistant
- Tacoma, WA
National Provider Identifier
1033744552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 9040 Jackson Ave
Tacoma, WA 98431-7324 - Phone
- (253) 968-1110
- NPI assigned
- Mar 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
9040 Jackson Ave
Tacoma, WA 98431-7324
Mailing address
2817 Reilly St
Fort Bragg, NC 28310-7324
Phone (910) 907-6069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250711001196 | WA | Order and Referring Only - Emergency Medicine | 5395250278 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677456000000",
"number": "1033744552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 REILLY ST",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107324",
"telephone_number": "910-907-6069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984317324",
"telephone_number": "253-968-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEN",
"first_name": "MEKKO",
"middle_name": "KAMARA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-04",
"last_updated": "2023-02-27",
"certification_date": "2023-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.