Provider Demographics
NPI:1164663613
Name:KIM, CATHERINE M (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:KIM
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NW 54TH ST STE 378
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3575
Mailing Address - Country:US
Mailing Address - Phone:206-588-5578
Mailing Address - Fax:206-374-2463
Practice Address - Street 1:1417 NW 54TH ST STE 378
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3575
Practice Address - Country:US
Practice Address - Phone:206-588-5578
Practice Address - Fax:206-374-2463
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683042163WM0705X
NYF401451-1363LP0808X
CA19159363LP0808X
CA3253364S00000X
WAAP60222250363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036199Medicaid
WA2036199Medicaid