Provider Demographics
NPI:1336313519
Name:EVERTON, KATHRYN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LOUISE
Last Name:EVERTON
Suffix:
Gender:F
Credentials:MD
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 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-006872085R0202X
WAMD603143122085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8918995OtherPTAN-UAOM
WAG8918994OtherPTAN-MEDICAL IMAGING ON 1ST
WAG8918998OtherPTAN-TACOMA RADIOLOGICAL ASSOCIATES, KING CO
WAP01251119OtherRR MEDICARE-TRA
WAG8918996OtherPTAN-CAROL MILGARD BREAST CENTER
WAP01251104OtherRR MEDICARE-CMBC
WAG8918997OtherPTAN-TACOMA RADIOLOGICAL ASSOCIATES, PIERCE CO