Provider Demographics
NPI:1679090260
Name:JEWELL, KARIELLE B (PA-C)
Entity type:Individual
Prefix:
First Name:KARIELLE
Middle Name:B
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARIELLE
Other - Middle Name:
Other - Last Name:BRUGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:20200 54TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6389
Mailing Address - Country:US
Mailing Address - Phone:425-672-6400
Mailing Address - Fax:425-672-6518
Practice Address - Street 1:20200 54TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6318
Practice Address - Country:US
Practice Address - Phone:425-672-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60796477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty