Provider Demographics
NPI:1679459978
Name:FAYLES, SPENCER PATRICK (PA-S)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:PATRICK
Last Name:FAYLES
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 39TH AVE SW APT J302
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3660
Mailing Address - Country:US
Mailing Address - Phone:801-706-8335
Mailing Address - Fax:
Practice Address - Street 1:4505 S MERIDIAN STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5002
Practice Address - Country:US
Practice Address - Phone:253-697-5780
Practice Address - Fax:253-864-2972
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical