Provider Demographics
NPI:1619041456
Name:SKIDMORE, KAREN (DPM PS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:DPM PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20700 BOND RD NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9099
Mailing Address - Country:US
Mailing Address - Phone:360-697-3668
Mailing Address - Fax:360-697-3610
Practice Address - Street 1:20700 BOND RD NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9099
Practice Address - Country:US
Practice Address - Phone:360-697-3668
Practice Address - Fax:360-697-3610
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000508213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA9999OtherMUTUAL OF OMAHA
WA0166066OtherLABOR & INDUSTRIES
WA8477598Medicaid
WADA5130OtherRAILROAD MEDICARE
WA00010913OtherPACIFICARE
WA91217091100OtherUNIFORM MEDICAL PLAN
WA141708141710OtherPREMERA
WA4550430OtherAETNA
WA2106608OtherCOMMUNITY HLTH NETWORK WA
WA9121709110001OtherCIGNA HEALTH CARE
WA91217091101OtherKPS
WA0166066OtherLABOR & INDUSTRIES
WAWA9999OtherMUTUAL OF OMAHA