Basic Information
| Provider Information | |||||||||
| NPI: | 1134792617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOAN | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, MPH, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4111 ALDERWOOD MALL BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256164100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4111 ALDERWOOD MALL BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256164100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2021 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 61202048 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 61173482 | WA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 163876 | CT | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP61202048 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 61208819 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.