Basic Information
| Provider Information | |||||||||
| NPI: | 1740954965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEWSON | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | DEVIN | ||||||||
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| Credential: | CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7424 BRIDGEPORT WAY W STE 103 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7424 BRIDGEPORT WAY W STE 103 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2021 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 61202906 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 61202906 | 05 | WA | MEDICAID |