Provider Demographics
NPI:1447427794
Name:MCDANIEL, KATHRYN A (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W ROSE ST
Mailing Address - Street 2:FAMILY MEDICAL CENTER
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1662
Mailing Address - Country:US
Mailing Address - Phone:509-525-6650
Mailing Address - Fax:
Practice Address - Street 1:501 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-494-6700
Practice Address - Fax:509-573-6275
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00111214163WC1500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator