Provider Demographics
NPI:1053349043
Name:CLOWER, ATHALIA L (PA-C)
Entity type:Individual
Prefix:
First Name:ATHALIA
Middle Name:L
Last Name:CLOWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:945 GOETHALS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3552
Mailing Address - Country:US
Mailing Address - Phone:509-942-6327
Mailing Address - Fax:509-946-0908
Practice Address - Street 1:3950 KEENE RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-4901
Practice Address - Country:US
Practice Address - Phone:509-942-3130
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA319211600OtherGROUP MEDICARE PIN
WA8332116Medicaid
WAAB37073Medicare PIN
WAS20104Medicare UPIN