NPIMap

Organization Active NPI

Privia Medical Group Washington, PLLC

Doing business as Walla Walla Clinic

  • Family Nurse Practitioner
  • Walla Walla, WA
National Provider Identifier
1467715847
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60297383 Issued in WA
Legal business name
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Doing business as
Walla Walla Clinic
Practice address
55 W Tietan St
Walla Walla, WA 99362-4445
Phone
(509) 525-3720
Fax
(509) 522-1593
NPI assigned
Jun 20, 2012
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Kevin J Michelson
Title
Ceo
Phone
(509) 525-3720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60297383 WA Primary

Addresses

Primary practice location

55 W Tietan St
Walla Walla, WA 99362-4445

Mailing address

55 W Tietan St
Walla Walla, WA 99362-4445
Phone (509) 525-3720

Other names 1

  • Walla Walla Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Walla Walla Clinic Surg7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1467715847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "MICHELSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-525-3720"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60297383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walla Walla Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walla Walla Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.