Provider Demographics
NPI:1871010306
Name:JOHNSON, KATHLEEN ELIZABETH (DNP, ARNP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 DAYTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2715
Mailing Address - Country:US
Mailing Address - Phone:425-736-9609
Mailing Address - Fax:877-631-6941
Practice Address - Street 1:NOT TO BE PUBLISHED
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2715
Practice Address - Country:US
Practice Address - Phone:425-736-9609
Practice Address - Fax:833-631-6941
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60786815363L00000X, 363LF0000X, 363LP0808X
OR202203554NP-PP363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily