Provider Demographics
NPI:1598875965
Name:MCBROOM, KATHLEEN (ARNP,CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:ARNP,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2474
Mailing Address - Country:US
Mailing Address - Phone:206-461-6935
Mailing Address - Fax:206-461-8382
Practice Address - Street 1:201 16TH AVE E
Practice Address - Street 2:MS: CWB-2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5226
Practice Address - Country:US
Practice Address - Phone:206-324-1449
Practice Address - Fax:206-324-6977
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005457363LX0001X
WARN00129228163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9639154Medicaid
WAG8883365Medicare PIN
8800900Medicare ID - Type Unspecified45TH ST. CLINIC
8800898Medicare ID - Type UnspecifiedGREENWOOD CLINIC
8800902Medicare ID - Type UnspecifiedHIGH POINT CLINIC
8800896Medicare ID - Type UnspecifiedRAINIERPARK CLINIC
WAG8883366Medicare PIN
WA9639154Medicaid
P56513Medicare UPIN
8800894Medicare ID - Type UnspecifiedMIDWIFERY CLINIC