Provider Demographics
NPI:1902573330
Name:MONTANO, KAYLEE JOY (PA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JOY
Last Name:MONTANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:JOY
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 S 13TH ST STE 300
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4100
Practice Address - Country:US
Practice Address - Phone:360-336-9757
Practice Address - Fax:360-814-5237
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61343261363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical