Provider Demographics
NPI:1922251305
Name:PEPPLE, KATHRYN LYNN (MD PHD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYNN
Last Name:PEPPLE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:908 JEFFERSON ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2433
Practice Address - Country:US
Practice Address - Phone:206-744-8638
Practice Address - Fax:206-897-4320
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60336664207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922251305Medicaid
WA1922251305Medicaid