Active NPI 1508830423 Individual Practitioner Male Practitioner

Kenneth V Busby , BS, BA

Physician Assistant • Walla Walla, WA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Kenneth Busby, BS, BA is a certified Physician Assistant practicing in Walla Walla, WA. With approximately 28 years of clinical experience since completing medical education in 1998, Kenneth Busby delivers high-quality medical care to the local community at 55 W TIETAN ST.

Kenneth Busby is affiliated with Privia Medical Group Washington Pllc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

55 W Tietan St

Walla Walla, WA 993624445

Telephone 5095253720

Fax 5095254691

Associated Practice Facility / Clinic

🏢 Privia Medical Group Washington, Pllc Facility NPI 1780658419

Medicare Profile & Education

Medical School

Other

Graduation Year

1998

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Walla Walla, WA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

28 Yrs +17.9 yrs vs City Avg

City Avg: 10.1 Yrs

State Avg: 12.1 Yrs

Regional Practice Density

29 Specialists

Practicing in Walla Walla, WA (3774 Statewide)

Telehealth Adoption Rate

3.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

68.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Busby (28 Years) 28 Yrs

Walla Walla Specialty Average (10.1 Years) 10.1 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,598	429	$17.00	$5.71
99213 Established patient office or other outpatient visit, typically 15 minutes	1,155	812	$228.00	$76.97
17000 Destruction of skin growth	748	572	$193.00	$43.92
11102 Tangential biopsy of single skin lesion	426	348	$263.00	$76.31
17110 Destruction of up to 14 skin growths	420	347	$294.00	$97.95
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	370	251	$323.00	$107.13
11103 Biopsy of related skin growth, each additional growth	160	86	$130.00	$43.12
17004 Destruction of precancer skin growth, 15 or more growths	137	108	$600.00	$143.85
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	115	115	$283.00	$94.66
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	53	42	$459.00	$126.99
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	41	37	$783.00	$257.94
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	29	29	$420.00	$141.59
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	25	$629.00	$116.13
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	27	27	$143.00	$48.21
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	23	21	$657.00	$389.12
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	23	21	$366.00	$118.80
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	18	18	$715.00	$123.01
11104 Punch biopsy, first skin growth	18	17	$325.00	$107.34
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	15	13	$496.00	$154.53
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	14	13	$860.00	$275.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,610	413	$34.46	$5.81
99213 Established patient office or other outpatient visit, typically 15 minutes	1,142	784	$220.92	$76.88
17000 Destruction of skin growth	728	553	$175.93	$44.81
11102 Tangential biopsy of single skin lesion	455	375	$257.33	$79.11
96900 Application of ultraviolet light to skin	368	11	$58.05	$21.29
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	365	255	$307.57	$106.91
17110 Destruction of up to 14 skin growths	331	270	$287.42	$98.57
17004 Destruction of precancer skin growth, 15 or more growths	184	136	$590.33	$146.35
11103 Biopsy of related skin growth, each additional growth	172	95	$130.00	$43.65
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	91	91	$276.14	$93.97
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	55	39	$452.65	$130.59
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	43	39	$785.16	$263.29
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	26	$628.64	$105.70
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	26	19	$655.00	$384.73
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	22	21	$716.59	$120.21
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	22	19	$363.18	$123.23
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	20	20	$415.00	$141.49
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$136.50	$48.24
11104 Punch biopsy, first skin growth	16	14	$322.50	$104.31

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,416	412	$35.00	$5.87
99213 Established patient office or other outpatient visit, typically 15 minutes	992	716	$170.00	$76.88
17000 Destruction of skin growth	709	550	$175.00	$45.17
11102 Tangential biopsy of single skin lesion	415	354	$240.00	$79.82
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	353	245	$255.00	$107.12
17110 Destruction of up to 14 skin growths	344	281	$265.00	$98.21
17004 Destruction of precancer skin growth, 15 or more growths	157	117	$590.00	$146.09
11103 Biopsy of related skin growth, each additional growth	144	79	$130.00	$44.23
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	117	117	$260.00	$95.42
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	53	15	$3.58	$1.12
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	35	30	$730.00	$263.38
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	34	34	$395.00	$141.85
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	30	25	$420.00	$136.12
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	28	$105.00	$48.18
11900 Injection into skin growth, 1-7 growths	29	14	$135.00	$43.96
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	26	20	$655.00	$388.45
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	25	20	$340.00	$126.66
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	20	$595.00	$105.53
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	17	$685.00	$119.84
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	18	17	$460.00	$153.39
36415 Insertion of needle into vein for collection of blood sample	18	14	$20.00	$2.64
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	15	12	$60.00	$7.12
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	11	11	$750.00	$289.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,306	402	$35.00	$5.65
99213 Established patient office or other outpatient visit, typically 15 minutes	1,094	762	$170.08	$77.92
17000 Destruction of skin growth	707	546	$175.00	$46.01
11102 Tangential biopsy of single skin lesion	343	298	$240.00	$83.28
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	305	232	$255.00	$110.20
17110 Destruction of up to 14 skin growths	258	221	$265.00	$98.79
17004 Destruction of precancer skin growth, 15 or more growths	143	105	$590.00	$144.25
96900 Application of ultraviolet light to skin	131	11	$50.00	$20.37
11103 Biopsy of related skin growth, each additional growth	113	80	$130.00	$45.73
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	89	89	$260.00	$96.18
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	45	26	$655.00	$388.89
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	37	36	$105.00	$48.33
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	35	26	$340.00	$127.74
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	29	25	$460.00	$159.41
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	26	25	$420.00	$143.46
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	26	25	$730.00	$269.35
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	18	18	$395.00	$143.54
99202 New patient office or other outpatient visit, typically 20 minutes	17	17	$175.00	$62.65
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	15	$595.00	$107.85
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	13	$685.00	$148.56
87220 Tissue fungi or parasites	12	11	$35.00	$4.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,430	432	$35.00	$5.26
99213 Established patient office or other outpatient visit, typically 15 minutes	969	642	$170.00	$64.84
17000 Destruction of skin growth	705	555	$175.00	$47.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	473	409	$255.00	$93.66
11102 Tangential biopsy of single skin lesion	430	378	$240.00	$86.48
96900 Application of ultraviolet light to skin	199	13	$50.00	$19.74
11103 Biopsy of related skin growth, each additional growth	162	100	$130.00	$46.80
17004 Destruction of precancer skin growth, 15 or more growths	117	94	$590.00	$139.08
99202 New patient office or other outpatient visit, typically 20 minutes	114	114	$175.00	$65.58
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	49	13	$3.26	$1.46
36415 Insertion of needle into vein for collection of blood sample	39	21	$20.00	$2.89
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	31	28	$730.00	$257.18
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	30	25	$655.00	$381.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	26	$105.00	$39.60
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	29	29	$260.00	$93.37
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	29	28	$420.00	$133.67
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	27	24	$460.00	$147.07
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	27	25	$340.00	$115.06
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	23	$595.00	$108.19
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	25	16	$60.00	$7.53
17110 Destruction of up to 14 skin growths	24	21	$265.00	$96.76
11900 Injection into skin growth, 1-7 growths	23	12	$135.00	$45.28
11104 Punch biopsy, first skin growth	22	20	$300.00	$110.81
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	15	13	$685.00	$131.96
87220 Tissue fungi or parasites	11	11	$35.00	$4.25

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,703	477	$35.00	$4.87
99213 Established patient office or other outpatient visit, typically 15 minutes	1,043	694	$170.00	$63.89
17000 Destruction of skin growth	787	607	$175.00	$46.49
11102 Tangential biopsy of single skin lesion	496	405	$240.00	$83.87
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	452	395	$255.00	$92.93
11103 Biopsy of related skin growth, each additional growth	269	133	$130.00	$45.84
17004 Destruction of precancer skin growth, 15 or more growths	157	121	$590.00	$131.06
99202 New patient office or other outpatient visit, typically 20 minutes	123	123	$175.00	$65.58
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	46	46	$260.00	$93.44
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	42	14	$3.65	$1.58
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	41	31	$655.00	$392.73
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	38	36	$235.00	$66.15
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	31	23	$460.00	$136.91
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	31	27	$340.00	$108.24
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	29	26	$420.00	$112.08
11900 Injection into skin growth, 1-7 growths	26	14	$135.00	$42.69
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	23	$105.00	$38.99
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	24	22	$1030.00	$375.92
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	22	17	$685.00	$129.24
36415 Insertion of needle into vein for collection of blood sample	22	16	$20.00	$2.94
11104 Punch biopsy, first skin growth	19	19	$300.00	$102.65
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	16	15	$595.00	$108.24
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	16	16	$955.00	$338.50
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	12	11	$285.00	$95.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,671	426	$35.00	$4.49
99213 Established patient office or other outpatient visit, typically 15 minutes	1,044	693	$170.00	$62.11
17000 Destruction of skin growth	742	553	$175.00	$45.50
11100 Biopsy of single growth of skin and/or tissue	484	408	$250.00	$88.31
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	442	377	$255.00	$91.13
11101 Biopsy of each additional growth of skin and/or tissue	197	118	$80.00	$27.98
96900 Application of ultraviolet light to skin	166	11	$50.00	$17.96
17004 Destruction of precancer skin growth, 15 or more growths	127	99	$590.00	$124.16
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	92	56	$644.57	$398.20
99202 New patient office or other outpatient visit, typically 20 minutes	70	70	$175.00	$63.70
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	63	44	$340.00	$98.85
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	51	41	$225.78	$64.50
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	46	35	$420.00	$124.55
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	38	38	$260.00	$92.09
17110 Destruction of up to 14 skin growths	29	29	$265.00	$93.28
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	28	18	$460.00	$132.85
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	24	20	$285.00	$87.97
36415 Insertion of needle into vein for collection of blood sample	22	16	$20.00	$2.94
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	17	$105.00	$37.48
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	20	$685.00	$122.24
87220 Tissue fungi or parasites	19	19	$35.00	$4.96
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	18	18	$1030.00	$341.83
96573 Application of light by qualified health care professional to destroy precancer skin growth	15	15	$460.00	$163.22
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	15	15	$955.00	$340.21
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	11	$595.00	$106.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,080	359	$33.73	$4.75
99213 Established patient office or other outpatient visit, typically 15 minutes	847	589	$169.53	$61.36
17000 Destruction of skin growth	593	461	$175.49	$43.83
11100 Biopsy of single growth of skin and/or tissue	480	421	$231.06	$84.44
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	408	357	$255.54	$90.14
11101 Biopsy of each additional growth of skin and/or tissue	213	132	$79.62	$27.54
96900 Application of ultraviolet light to skin	164	12	$50.00	$17.86
17004 Destruction of precancer skin growth, 15 or more growths	159	126	$588.60	$127.31
17110 Destruction of up to 14 skin growths	100	87	$243.25	$93.54
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	90	46	$555.33	$352.41
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	80	46	$340.00	$115.97
99202 New patient office or other outpatient visit, typically 20 minutes	70	70	$175.47	$62.91
36415 Insertion of needle into vein for collection of blood sample	32	18	$19.56	$2.94
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	31	26	$387.74	$112.16
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	21	$552.88	$105.23
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	24	24	$934.04	$335.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	23	$103.52	$35.81
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$259.52	$90.96
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	22	19	$1008.09	$353.33
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	17	17	$466.88	$167.88
87220 Tissue fungi or parasites	13	13	$33.77	$5.74

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License WA PA10004990

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

8444994 (WA)

Commercial Insurance / Payer ID Rail Road Medicare

P00290212 (WA)

Commercial Insurance / Payer ID L&i

0205798 (WA)

Hospital & Practice Group Affiliations

Privia Medical Group Washington Pllc

55 W Tietan St, Walla Walla, WA 993624445

Phone: 50952537201405

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Dr. Kevin Molander , MD

Family Medicine

NPI 1013975036

Doctor of Medicine (M.D.)

Stacey Haveman , PHYSICIAN ASSISTANT

Physician Assistant - Medical

NPI 1023309796

PHYSICIANASSISTANT

Dr. Jennifer Bolduc , MD

Pediatrics

NPI 1033183256

Doctor of Medicine (M.D.)

Dr. Justin Olswanger , DO

Family Medicine - Adult Medicine

NPI 1033265657

Doctor of Osteopathic Medicine (D.O.)

Dr. John Moore , DO

Family Medicine

NPI 1063412070

Doctor of Osteopathic Medicine (D.O.)

Dr. Timothy O'connor , MD

Pediatrics

NPI 1073856043

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active November 27, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location November 27, 2007

Registered at 55 W TIETAN ST, WALLA WALLA, WA 993624445 (Tel: 5095253720)

📍

Updated Business Mailing Address November 27, 2007

Registered at 55 W TIETAN ST, WALLA WALLA, WA 993624445 (Tel: 5095253720)

👤

Provider Name / Credentials Updated November 27, 2007

Recorded as KENNETH BUSBY, B.S. / B.A.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 27, 2007

Physician Assistant (License #PA10004990 in WA)

🟢

Initial NPI Registration & Enumeration February 15, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1508830423

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 15, 2006

Last Update: November 27, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

55 W Tietan St

Walla Walla, WA 993624445

Phone: 5095253720

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.