Provider Demographics
NPI:1962513853
Name:LAYLAND, KIMM I (PAC)
Entity type:Individual
Prefix:
First Name:KIMM
Middle Name:I
Last Name:LAYLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KIMM
Other - Middle Name:I
Other - Last Name:BELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1990 HOSPITAL DRIVE, SUITE 100
Practice Address - Street 2:SKAGIT REGIONAL CLINICS-SEDRO WOOLLEY FAMILY MEDICINE
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-856-4141
Practice Address - Fax:360-856-4145
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS85430Medicare UPIN