Basic Information
| Provider Information | |||||||||
| NPI: | 1134255938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | THENA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 JOSEPH SIEWICK DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11511 CANTERWOOD BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA10005153 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 0110001717 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA10005153 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0251995 | 01 | WA | STATE L&I | OTHER | 2003416 | 05 | WA | MEDICAID |