Provider Demographics
NPI:1144215567
Name:HENSCH-FLEMING, KATHLEEN JO (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JO
Last Name:HENSCH-FLEMING
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:SUITE 255
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-885-7926
Mailing Address - Fax:360-802-0208
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 255
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-885-7926
Practice Address - Fax:360-802-0208
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003236367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615287Medicaid