Provider Demographics
NPI:1093902413
Name:PERRY, CHADWICK JAY (PA C)
Entity type:Individual
Prefix:MR
First Name:CHADWICK
Middle Name:JAY
Last Name:PERRY
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3525
Mailing Address - Country:US
Mailing Address - Phone:509-713-1315
Mailing Address - Fax:877-673-0795
Practice Address - Street 1:969 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3525
Practice Address - Country:US
Practice Address - Phone:509-713-1315
Practice Address - Fax:877-673-0795
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3003PEOtherBSWA
WA8495541Medicaid
WA0225690OtherLIWA
WAG8869032Medicare PIN