Provider Demographics
NPI:1376542514
Name:VANKESSEL, KATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:VANKESSEL
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 1:1231 116TH AVE NE
Mailing Address - Street 2:STE 950
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3832
Mailing Address - Country:US
Mailing Address - Phone:425-943-3219
Mailing Address - Fax:425-646-5198
Practice Address - Street 1:1231 116TH AVE NE
Practice Address - Street 2:SUITE 950
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3804
Practice Address - Country:US
Practice Address - Phone:425-454-3366
Practice Address - Fax:425-943-3201
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8263980Medicaid
WAH20900Medicare UPIN
WAAB16502Medicare PIN