Provider Demographics
NPI:1003664624
Name:OFF THE GRID MIDWIFERY & HEALTH LLC
Entity type:Organization
Organization Name:OFF THE GRID MIDWIFERY & HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, ARNP
Authorized Official - Phone:253-509-2960
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98322-0294
Mailing Address - Country:US
Mailing Address - Phone:253-509-2960
Mailing Address - Fax:306-400-2735
Practice Address - Street 1:4707 S JUNETT ST STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6480
Practice Address - Country:US
Practice Address - Phone:360-633-9146
Practice Address - Fax:306-400-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty