Provider Demographics
NPI:1528065265
Name:SHUEY, JACKIE SUE (PA)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:SUE
Last Name:SHUEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S 348TH ST STE B103
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7027
Mailing Address - Country:US
Mailing Address - Phone:253-237-8050
Mailing Address - Fax:253-661-9132
Practice Address - Street 1:1105 S 348TH ST STE B103
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7027
Practice Address - Country:US
Practice Address - Phone:250-323-7800
Practice Address - Fax:253-661-9132
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004350363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8372269Medicaid
WAQ08970Medicare UPIN
WA8372269Medicaid