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MR. GUILLERMO VALES KENNEDY PA-C
NPI 1679130322
Physician Assistant - Surgical in Mount Vernon, WA

Active since May 28, 2019PECOS EnrolledAccepts Medicare Assignment
1500 CONTINENTAL PL, MOUNT VERNON, WA 98273(360) 424-7041(360) 424-2418 Get Directions Write a Review

NPPES record last updated: June 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 12, 2019, May 28, 2019 (2 updates tracked since 2019).

About Mr. Guillermo Vales Kennedy Pa-c NPPES

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

MR. GUILLERMO VALES KENNEDY PA-C (NPI 1679130322) is an individual surgical provider in Mount Vernon, Washington, licensed in Washington (PA60912831) and active in the NPI registry since May 2019. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1679130322
Entity TypeIndividualMale
Primary Taxonomy363AS0400X
Provider Legal NameMR. GUILLERMO VALES KENNEDYCredential: PA-C
Location Address1500 CONTINENTAL PLMount Vernon, WA 98273
Mailing Address1401 S Laventure RdMount Vernon, WA 98274-6033 · (360) 424-7041
Phone(360) 424-7041
Fax(360) 424-2418
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateMay 28, 2019
Last NPPES UpdateJune 2, 20222 updates tracked since enumeration
NPPES CertifiedJune 2, 2022
✔ NPI 1679130322 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in WA · PA60912831
Also ListedPhysician AssistantTaxonomy 363A00000X
1500 CONTINENTAL PL, Mount Vernon, WA 98273
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Secondary Practice Locations 2

Location 11630 NE Valley Rd Apt D101Pullman, WA 99163-4419 · Phone (646) 573-5979
Location 21401 S Laventure RdMount Vernon, WA 98274-6033 · Phone (360) 424-7041 · Fax (360) 424-2418

Other Identifiers 1

Medicaid2137460WA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Guillermo Vales Kennedy Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4789915075
PECOS Enrollment IDI20200914000586
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 16

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

KEELYMAE J REGAN DPT
Physical Therapist
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
PROLIANCE SURGEONS, INC., P.S.
Clinic/Center (Magnetic Resonance Imaging (MRI))
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
STEPHEN J MILLER D.P.M.
Podiatrist
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
MARK S VOLLRATH PA-C
Physician Assistant
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
KRISTEN ERIN ROBERTS PA-C
Physician Assistant (Surgical)
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
SCOTT MICHAEL ELY PA-C
Physician Assistant (Surgical)
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
PROLIANCE SURGEONS, INC., P.S.
Clinic/Center (Ambulatory Surgical)
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041
MS. CARYN ANNE CLIPPERT PA-C
Physician Assistant (Surgical)
1500 CONTINENTAL PL
MOUNT VERNON, WA 98273
Skagit County (360) 424-7041

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 Guillermo Vales Kennedy's NPI number?

The NPI number for Guillermo Vales Kennedy is 1679130322. It was assigned to this individual provider in the NPPES registry on May 28, 2019.

Where is Guillermo Vales Kennedy located?

Guillermo Vales Kennedy practices at 1500 Continental Pl, Mount Vernon, WA 98273. The listed phone number is (360) 424-7041.

What is Guillermo Vales Kennedy's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Guillermo Vales Kennedy enrolled in Medicare?

Yes. Guillermo Vales Kennedy is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Guillermo Vales Kennedy was last updated on June 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.