Provider Demographics
NPI:1386680973
Name:LEACH, KATHLEEN G (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:LEACH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3116
Mailing Address - Country:US
Mailing Address - Phone:425-774-6691
Mailing Address - Fax:
Practice Address - Street 1:221 4TH AVE N
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3116
Practice Address - Country:US
Practice Address - Phone:425-774-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8879512Medicare PIN
WA8860383Medicare PIN