Provider Demographics
NPI:1225234792
Name:MOSER, KATHRYN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:MOSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W OLYMPIC PL
Mailing Address - Street 2:#5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3646
Mailing Address - Country:US
Mailing Address - Phone:206-227-8173
Mailing Address - Fax:
Practice Address - Street 1:515 W OLYMPIC PL
Practice Address - Street 2:#5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3646
Practice Address - Country:US
Practice Address - Phone:206-227-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant