Individual provider Active NPI

Lynda Kim Le, PA-C

  • Physician Assistant
  • Everett, WA
National Provider Identifier
1063694875
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61139478 Issued in WA
Practice address
3305 Nassau St
Everett, WA 98201-4140
Phone
(206) 895-1825
NPI assigned
Dec 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 23012294 NY
Physician Assistant 363A00000X PA1228 NV
Physician Assistant 363A00000X PA0219 NV
Physician Assistant 363A00000X PA2360 NV
Physician Assistant 363A00000X PA61139478 WA Primary

Addresses

Primary practice location

3305 Nassau St
Everett, WA 98201-4140

Mailing address

12634 Triangle Reef CT
Las Vegas, NV 89141-6118
Phone (215) 805-0477

Other practice location 1

874 American Pacific Dr
Henderson, NV 89014-8800
Phone (215) 805-0477

Other identifiers 1

IdentifierTypeStateIssuer
11973110OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1228NVMDPhysician Assistant
PA2360NVMDPhysician Assistant
23012294NYMDPhysician Assistant
PA61139478WAMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1063694875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12634 TRIANGLE REEF CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891416118",
            "telephone_number": "215-805-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 NASSAU ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014140",
            "telephone_number": "206-895-1825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "874 American Pacific Dr",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890148800",
            "country_code": "US",
            "telephone_number": "215-805-0477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE",
        "first_name": "LYNDA",
        "middle_name": "KIM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23012294",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1228",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA0219",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2360",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61139478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11973110",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.