Provider Demographics
NPI:1013483064
Name:MCKINNON, KATHERINE (RN, NP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S GOLD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3768
Mailing Address - Country:US
Mailing Address - Phone:360-807-4929
Mailing Address - Fax:844-612-6673
Practice Address - Street 1:1126 S GOLD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3768
Practice Address - Country:US
Practice Address - Phone:206-234-9139
Practice Address - Fax:844-612-6673
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60082163163W00000X
WAAP61584538363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse