Provider Demographics
NPI:1235262528
Name:GUNN, KATHI L (ARNP FNPBC)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:L
Last Name:GUNN
Suffix:
Gender:F
Credentials:ARNP FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0806
Mailing Address - Country:US
Mailing Address - Phone:360-808-7533
Mailing Address - Fax:360-582-1985
Practice Address - Street 1:519 EUREKA WAY STE 1
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5086
Practice Address - Country:US
Practice Address - Phone:360-808-7533
Practice Address - Fax:360-582-1985
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO06968Medicare UPIN
WA06968Medicare UPIN