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

Kevin DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1386252252

Kevin DO is a Physician Assistant in Puyallup, Washington. Qualified in 2021, 5 years ago. Practices with Proliance Surgeons Inc P S, a 394-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
5
Licensed in
WA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

3801 5th St SE Ste 110
Puyallup, WA 98374-2106
Phone: (253) 845-9585
Fax: (253) 848-1126
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 20920 State Route 410 E, Bonney Lake, WA 98391-6302 — (253) 845-9585

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA61175518 (WA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1386252252
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 16, 2020
Last updated in NPPESFebruary 17, 2022
Certification dateFebruary 17, 2022
Mailing address3801 5th St Se Ste 110, Puyallup, WA 98374-2106

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Proliance Surgeons Inc P S — 394 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Puyallup