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PRIVIA MEDICAL GROUP WASHINGTON, PLLC
NPI 1780658419
Clinic/Center in Walla Walla, WA

Active since February 17, 2006
55 W TIETAN ST, WALLA WALLA, WA 99362(509) 525-3720(509) 522-1592 Get Directions Write a Review

NPPES record last updated: December 23, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 23, 2025, Oct 6, 2023, Dec 18, 2017 (3 updates tracked since 2017).

About Privia Medical Group Washington, Pllc NPPES

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

PRIVIA MEDICAL GROUP WASHINGTON, PLLC (NPI 1780658419), doing business as Walla Walla Clinic (professional), is a healthcare organization registered as a clinic/center in Walla Walla, Washington and active in the NPI registry since February 2006. The organization lists Kevin Michelson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1780658419
Entity TypeOrganization
Primary Taxonomy261Q00000X
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) 522-1592
Phone(509) 525-3720
Fax(509) 522-1592
Organization SubpartNo
Authorized OfficialKevin MichelsonCeo · (509) 525-3720
Enumeration DateFebruary 17, 2006
Last NPPES UpdateDecember 23, 20253 updates tracked since enumeration
NPPES CertifiedDecember 23, 2025
✔ NPI 1780658419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Also ListedFamily MedicineTaxonomy 207Q00000X
55 W TIETAN ST, Walla Walla, WA 99362
Open in Google Maps ↗

Other Names 1

Doing Business AsWalla Walla Clinic (professional)

Other Identifiers 3

Medicaid208199OR
Other30200WA · L&i
Medicaid7809205WA

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

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 1780658419. It was assigned to this organization in the NPPES registry on February 17, 2006. The provider is doing business as Walla Walla Clinic (Professional).

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 Clinic/Center with taxonomy code 261Q00000X.

What insurance does Privia Medical Group Washington, PLLC accept?

Health plans from Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Privia Medical Group Washington, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Privia Medical Group Washington, PLLC was last updated on December 23, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.