Individual provider Active NPI

Shelley Anne Kemmerer

  • Physician Assistant
  • Kirkland, WA
National Provider Identifier
1922456631
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1147075 Issued in WA
Practice address
10415 NE 37TH Cir Ste 3
Kirkland, WA 98033-7924
Phone
(206) 707-3490
NPI assigned
Jun 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

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 1147075 WA Primary

Addresses

Primary practice location

10415 NE 37TH Cir Ste 3
Kirkland, WA 98033-7924

Mailing address

10415 NE 37TH Cir Ste 3
Kirkland, WA 98033-7924
Phone (484) 619-0755

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171218001982 WA Practitioner - Physician Assistant 9436417680 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1147075WAMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1922456631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10415 NE 37TH CIR STE 3",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980337924",
            "telephone_number": "484-619-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10415 NE 37TH CIR STE 3",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980337924",
            "telephone_number": "206-707-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMMERER",
        "first_name": "SHELLEY",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "1147075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.