Suzette Widdison Iverson, MPH PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10004945 Issued in WA

Practice address

3003 Judson St
Gig Harbor, WA 98335-1219

Phone

(253) 234-7412

Fax

(253) 349-2132

NPI assigned

Dec 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Suzette Widdison Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: siverson20434@carelonhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peninsula Family Medical Center

  • Family Medicine Physician
  • Gig Harbor, WA
  • NPI 1588674998
  Medicare reassignment
• Carelon Medical Partners, PC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1124443403

  WA

  Medicare reassignment
• Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Port Orchard, WA
  • NPI 1205886934

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790121600000",
    "number": "1144204173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 JUDSON ST",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351219",
            "telephone_number": "253-235-7412",
            "fax_number": "253-349-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 JUDSON ST",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351219",
            "telephone_number": "253-234-7412",
            "fax_number": "253-349-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "SUZETTE",
        "middle_name": "WIDDISON",
        "credential": "MPH PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0291728",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8500191",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8907654",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0239348",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZETTE",
            "last_name": "WIDDISON",
            "credential": "MPHPAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Husby, ARNP
• Deanna Iff, AU.D.
• Leah J Inman, D.O.
• Integrative Therapeutic Solutions, LLC (Certified Aging in Place Occupational Therapy)
• Denise Marie Iversen, O.D.
• Adam S. Jackson, L.AC.
• Bruce E Jackson, MA
• James Allen Jackson, M.S.W.
• Trina Jackson, RBT
• Trisa Jackson, IHP

• Physician Assistant in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; 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.

Verify at the official NPI Registry.