Provider Demographics
NPI:1427030394
Name:KJOS, MARTHA JOYCE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JOYCE
Last Name:KJOS
Suffix:
Gender:F
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:8299 161ST AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3860
Practice Address - Country:US
Practice Address - Phone:425-881-8813
Practice Address - Fax:425-869-7201
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8355612Medicaid
WA970014933OtherMEDICARE RAILROAD
WA127603OtherLABOR & INDUSTRIES
WAKJ3097OtherBLUE SHIELD
WAG8897725Medicare PIN
WA8355612Medicaid
WAGAB10097Medicare PIN