Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carl Gannon, PA

Individual provider Medical Physician Assistant · NPI 1053668335

Carl Gannon, PA is a Nurse Practitioner in Everett, Washington. Qualified in 2004, 22 years ago. Practices with Providence Health and Services- Washington, a 526-clinician group and accepts Medicare assignment. Licensed in California and Washington.

Years since qualifying
22
Licensed in
CA, WA
In the registry since
2012
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

12800 Bothell Everett Hwy
Everett, WA 98208-6642
Phone: (425) 316-5180
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP60628896 (WA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 22398 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 22998 (CA)

Record details

NPI number1053668335
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 6, 2012
Last updated in NPPESMay 20, 2021
Certification dateMay 20, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Providence Health And Services- Washington — 526 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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