Basic Information
| Provider Information | |||||||||
| NPI: | 1962421230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 N CHELAN AVE | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988012028 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HIGHLINE DR | ||||||||
| Address2: | |||||||||
| City: | EAST WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988025341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098840614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA10004879 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 314772 | 01 | WA | L&I POST 7/21/13 | OTHER | 200822 | 01 | WA | L&I | OTHER | 8906911 | 01 | WA | CV | OTHER | P01257581 | 01 | WA | RR MEDICARE | OTHER | 1962421230 | 05 | WA | MEDICAID |