Provider Demographics
NPI:1003065533
Name:ROY, KATHY A (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:A
Last Name:ROY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 BETHEL RD SE STE 107
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5608
Mailing Address - Country:US
Mailing Address - Phone:360-373-8016
Mailing Address - Fax:360-616-2775
Practice Address - Street 1:1950 POTTERY AVE STE 25
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2590
Practice Address - Country:US
Practice Address - Phone:360-373-8016
Practice Address - Fax:360-616-2775
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00079324163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator