Provider Demographics
NPI:1073813424
Name:WITHERS, RICHARD L (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:WITHERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:WITHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6703 W RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2623
Mailing Address - Country:US
Mailing Address - Phone:509-460-5588
Mailing Address - Fax:509-783-5438
Practice Address - Street 1:6703 W RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2623
Practice Address - Country:US
Practice Address - Phone:509-460-5588
Practice Address - Fax:509-783-5438
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60460660363AS0400X, 363A00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036046Medicaid
WAP01547455OtherRR MEDICARE
WA331850OtherLABOR & INDUSTRIES
WA2036046Medicaid