Basic Information
| Provider Information | |||||||||
| NPI: | 1073163424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBERT | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 BROADWAY FL 6 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063862600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 BROADWAY FL 6 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063862600 | ||||||||
| FaxNumber: | 2066221644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1166017 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA61096386 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 2166017 | 05 | WA | MEDICAID |