Provider Demographics
NPI:1396780979
Name:KENOYER, KURT W (PA-C)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:KENOYER
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 1:6926 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7254
Mailing Address - Country:US
Mailing Address - Phone:360-993-3000
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7254
Practice Address - Country:US
Practice Address - Phone:360-993-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2159KEOtherREGENCE BLUESHIELD INS
WA9974KEOtherREGENCE BLUESHIELD INS
WA1009425Medicaid
WA9749KEOtherREGENCE BLUESHIELD INS
WA1599KEOtherREGENCE BLUESHIELD INS
WA8415440Medicaid
MK1169223OtherDEA
WA9749KEOtherREGENCE BLUESHIELD INS