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

Miranda K Detore, PA-C

Individual provider Surgical Physician Assistant · NPI 1720471774

Miranda K Detore, PA-C is a Physician Assistant in Spokane, Washington. Qualified in 2014, 12 years ago. Practices with Uptown Providers PC, a 43-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
12
Licensed in
WA
In the registry since
2015
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

217 W Cataldo Ave
Spokane, WA 99201-2217
Phone: (509) 747-6194
Fax: (509) 252-2837
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA60610394 (WA)
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1720471774
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 16, 2015
Last updated in NPPESFebruary 6, 2024
Certification dateFebruary 6, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Uptown Providers Pc — 43 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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