Kyle Thomas Krekow, PA-C
Individual provider Active NPI Physician Assistant · Duvall, WA
NPI 1851497549 · NPPES record last updated Jun 17, 2009
Key facts
- NPI
- 1851497549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA10005050 (WA)
- Practice address
- 14720 Main St NE
Suite 109
Duvall, WA 98019-8460 - Phone
- (425) 788-4889
- Fax
- (425) 844-6116
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061218000485 | WA | Practitioner - Physician Assistant | 3375542400 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10005050 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| King County Public Hospital District No. 2 | Current |
Accepting new patients | |
| King County Public Hospital District No 2 | Current |
Accepting new patients | |
| King County Public Hospital District No. 2 | Current | Accepting new patients |
Locations
1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988
14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889
12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10005050 | WA | Yes |
Addresses
Primary practice location
14720 Main St NE
Suite 109
Duvall, WA 98019-8460
Mailing address
PO Box 34036
Seattle, WA 98124-1036
Phone (425) 899-3292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00447839 | Other | MEDICARE RAILROAD | |
| 8463747 | Medicaid | WA |
Other providers in Duvall, WA
- Kids and Family Counseling, PLLC
- Alexis Kimball
- King County Fire District No 45
- Skye King
- Kristine Renae Kingsbury
- Lauren Valentine Kula
- Shelly Marie Kvamme
- Mayuri Lahane
- Aubrey Christine Lane
- Larch Counseling PLLC
All providers in Duvall, WA · Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.