Provider Demographics
NPI:1033461181
Name:BARRON, KATHRYN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:FAGERLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 SUNSET BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2803
Mailing Address - Country:US
Mailing Address - Phone:425-231-4376
Mailing Address - Fax:
Practice Address - Street 1:830 SUNSET BLVD NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2803
Practice Address - Country:US
Practice Address - Phone:425-231-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WAMW60331598176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula