NPIMap

Individual provider Active NPI

Brenda Kay Wilks, PA-C

  • Physician Assistant
  • Deer Park, WA
National Provider Identifier
1386996056
Registry record updated Oct 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60314280 Issued in WA
Practice address
509 East D Street
Deer Park, WA 99006-1529
Phone
(509) 276-5005
NPI assigned
Oct 5, 2012
Last updated
Oct 5, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60314280 WA Primary

Addresses

Primary practice location

509 East D Street
Deer Park, WA 99006-1529

Mailing address

PO Box 1529
Deer Park, WA 99006-1529

Other names 1

  • Brenda Kay Luther Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130508000041 WA Practitioner - Physician Assistant 1951548189 Reassigns benefits to 4 organizations
I20200121000204 ID Practitioner - Physician Assistant 1951548189 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1807 N Hutchinson Rd
Spokane Valley, WA 99212-2444
Phone 51293039091255

5905 N Mayfair St
Suite 200
Spokane, WA 99208-1127
Phone 51293039091255

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm - Blackhart PLLC Dermatology CurrentSince Apr 1, 2020 Accepting new patients
Mountain West Derm-Blackhart, PLLC Dermatology CurrentSince Apr 1, 2020 Accepting new patients
Multicare Health System CurrentSince Mar 1, 2018 Accepting new patients
Multicare Health System CurrentSince Mar 1, 2018 Accepting new patients
Advanced Dermatology and Skin Surgery PLLC CurrentSince Dec 1, 2019 Accepting new patients
Mountain West Derm - Blackhart PLLC Dermatology Past Accepting new patients

Locations

7733 W Emerald St
Boise, ID 83704
Phone (208) 376-4777

1700 W Riverstone Dr
Coeur D Alene, ID 83814
Phone (208) 770-2822

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

5905 N Mayfair St
#200
Spokane, WA 99208
Phone 51293039091255

1807 N Hutchinson Rd
Spokane Valley, WA 99212
Phone (509) 456-3414

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349395200000",
    "number": "1386996056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1529",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990061529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 EAST D STREET",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990061529",
            "telephone_number": "509-276-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKS",
        "first_name": "BRENDA",
        "middle_name": "KAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-05",
        "last_updated": "2012-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60314280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENDA",
            "last_name": "LUTHER",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Deer Park, WA

Sources for this page

Verify at the official NPI Registry.