Basic Information
| Provider Information | |||||||||
| NPI: | 1396763140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAPSON | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 YAKIMA AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532727777 | ||||||||
| FaxNumber: | 2538584348 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 YAKIMA AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532727777 | ||||||||
| FaxNumber: | 2538584348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA10004882 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA10004882 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1009401 | 05 | WA | MEDICAID | 8436040 | 05 | WA | MEDICAID |