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WALLA WALLA CLINIC
NPI 1467715847
Nurse Practitioner - Family in Walla Walla, WA

Active since June 20, 2012
55 W TIETAN ST, WALLA WALLA, WA 99362(509) 525-3720(509) 522-1593 Get Directions Write a Review

NPPES record last updated: October 6, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Walla Walla Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALLA WALLA CLINIC (NPI 1467715847) is a healthcare organization registered as a family in Walla Walla, Washington and active in the NPI registry since June 2012. The organization lists Kevin J Michelson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1467715847
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NamePRIVIA MEDICAL GROUP WASHINGTON, PLLC
Location Address55 W TIETAN STWalla Walla, WA 99362-4445
Mailing Address55 W Tietan StWalla Walla, WA 99362-4445 · (509) 525-3720 · Fax (509) 522-1593
Phone(509) 525-3720
Fax(509) 522-1593
Organization SubpartNo
Authorized OfficialKevin J MichelsonCeo · (509) 525-3720
Enumeration DateJune 20, 2012
Last NPPES UpdateOctober 6, 2023
NPPES CertifiedOctober 6, 2023
✔ NPI 1467715847 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in WA · AP60297383
55 W TIETAN ST, Walla Walla, WA 99362
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Other Names 1

Doing Business AsWalla Walla Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN JON MOLANDER M.D.
Family Medicine
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
STACEY RENEE HAVEMAN PHYSICIAN ASSISTANT
Physician Assistant (Medical)
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
JUSTIN OLSWANGER DO
Family Medicine (Adult Medicine)
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
DR. JOHN ERIC MOORE D.O.
Family Medicine
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
TIMOTHY ISAMU O'CONNOR M.D.
Pediatrics
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
REBEKAH DICKMAN M.D.
Pediatrics
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
DIANA FITZGERALD AU.D.
Audiologist
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
GUNNAR LEIGHTON JAMES SJOREN DPT
Physical Therapist
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Privia Medical Group Washington, PLLC's NPI number?

The NPI number for Privia Medical Group Washington, PLLC is 1467715847. It was assigned to this organization in the NPPES registry on June 20, 2012. The provider is doing business as Walla Walla Clinic.

Where is Privia Medical Group Washington, PLLC located?

Privia Medical Group Washington, PLLC is located at 55 W Tietan St, Walla Walla, WA 99362. The listed phone number is (509) 525-3720.

What is Privia Medical Group Washington, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Privia Medical Group Washington, PLLC was last updated on October 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.