Provider Demographics
NPI:1871521864
Name:CLOWER, RANDALL SHANE (PA-C)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:SHANE
Last Name:CLOWER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5600
Mailing Address - Country:US
Mailing Address - Phone:509-586-8368
Mailing Address - Fax:
Practice Address - Street 1:911 S WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5600
Practice Address - Country:US
Practice Address - Phone:509-586-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003813207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226765OtherL&I
WA8332090Medicaid
WA0226765OtherL&I
WAS53105Medicare UPIN