Provider Demographics
NPI:1902393861
Name:TURNER, KATHLEEN GRACE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5025
Mailing Address - Country:US
Mailing Address - Phone:360-493-5252
Mailing Address - Fax:360-493-5257
Practice Address - Street 1:3610 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5025
Practice Address - Country:US
Practice Address - Phone:360-493-5252
Practice Address - Fax:360-493-5257
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-07-31
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2018-12-05
Provider Licenses
StateLicense IDTaxonomies
WAMD61446537208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty