Provider Demographics
NPI:1083758924
Name:WILMERING, KATHY J (MSW ARNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:WILMERING
Suffix:
Gender:F
Credentials:MSW ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 CALIFORNIA AVE SW UNIT 16325
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-0816
Mailing Address - Country:US
Mailing Address - Phone:206-632-9522
Mailing Address - Fax:206-632-9522
Practice Address - Street 1:1915 25TH AVE S UNIT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4705
Practice Address - Country:US
Practice Address - Phone:206-632-9522
Practice Address - Fax:206-632-9522
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002439363LP0808X
WALH00006554104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR89575Medicare UPIN