1619527595 NPI number — KATHERINE DOREEN CARPENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619527595 NPI number — KATHERINE DOREEN CARPENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
KATHERINE
Provider Middle Name:
DOREEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAWKINSON
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
DOREEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619527595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 COLBY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-261-3559
Provider Business Mailing Address Fax Number:
425-261-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 COLBY AVE
Provider Second Line Business Practice Location Address:
C-WING FIRST FLOOR
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-261-3559
Provider Business Practice Location Address Fax Number:
425-261-3560
Provider Enumeration Date:
09/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  VA00021175 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013906528 . This is a "THIRD PARTY INSURANCES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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