Basic Information
| Provider Information | |||||||||
| NPI: | 1053818013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLAIN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| OtherLastName: | MCCLAIN | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 111 BREWSTER ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017292000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 33431 13TH PL S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538747634 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2018 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LP04409 | RI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OP61273088 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.