Provider Demographics
NPI:1922156025
Name:TIMM, KATHRYN LAVONNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LAVONNE
Last Name:TIMM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8814 SKOKOMISH WAY NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5949
Mailing Address - Country:US
Mailing Address - Phone:360-540-7423
Mailing Address - Fax:360-754-5793
Practice Address - Street 1:402 LEGION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1107
Practice Address - Country:US
Practice Address - Phone:360-570-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007134363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily