Active NPI
Timothy Valentine Cruickshank, PA
- Physician Assistant
- Seattle, WA
National Provider Identifier
1144370032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 60705908
- Practice address
- 805 Madison St Ste 701
Seattle, WA 98104-2099 - Phone
- (206) 707-9299
- Fax
- (206) 432-4552
- NPI assigned
- Jan 11, 2007
- Last updated
- Jul 29, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10535560 | NE | |
| Physician Assistant | 363A00000X | 60705908 | WA | Primary |
Addresses
Primary practice location
805 Madison St Ste 701
Seattle, WA 98104-2099
Mailing address
805 Madison St Ste 701
Seattle, WA 98104-2099
Phone (206) 707-9299
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10535560 | NE | MD | Physician Assistant |
| 60705908 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1144370032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 MADISON ST STE 701",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042099",
"telephone_number": "206-707-9299",
"fax_number": "206-432-4552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 MADISON ST STE 701",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042099",
"telephone_number": "206-707-9299",
"fax_number": "206-432-4552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUICKSHANK",
"first_name": "TIMOTHY",
"middle_name": "VALENTINE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "10535560",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "60705908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.