Provider Demographics
NPI:1659529345
Name:TUCHOLKE, KATHLEEN E (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:TUCHOLKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:YONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FN,P
Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-225-2707
Practice Address - Street 1:620 N PARK DR
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-4100
Practice Address - Country:US
Practice Address - Phone:509-697-5511
Practice Address - Fax:509-225-2707
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007234363LF0000X
WAAP60400436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2008004581OtherANCC CERTIFICATION