Basic Information
| Provider Information | |||||||||
| NPI: | 1598875965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCBROOM | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | ARNP,CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 SPRUCE ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064616935 | ||||||||
| FaxNumber: | 2064618382 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 16TH AVE E | ||||||||
| Address2: | MS: CWB-2 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063241449 | ||||||||
| FaxNumber: | 2063246977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | AP30005457 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 163WW0101X | RN00129228 | WA | Y | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
ID Information
| ID | Type | State | Issuer | Description | 9639154 | 05 | WA | MEDICAID |