Provider Demographics
NPI:1598749731
Name:WHITE, KATHLEEN A (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-0903
Mailing Address - Fax:253-968-0100
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0903
Practice Address - Fax:253-968-0100
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003426363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626508Medicaid
WA9626508Medicaid
WAAB14598Medicare ID - Type Unspecified