Provider Demographics
NPI:1306270137
Name:RANDALL-GAY, BRIANNE PATRICIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:PATRICIA
Last Name:RANDALL-GAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRIANNE
Other - Middle Name:PATRICIA
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:
Practice Address - Street 1:751 NE BLAKELY DR STE 2030
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:425-313-7080
Practice Address - Fax:425-313-7074
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60509009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306270137Medicaid