Provider Demographics
NPI:1023047214
Name:BRAULT, KATHRYN S (ARNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:BRAULT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 MANSFIELD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3588
Mailing Address - Country:US
Mailing Address - Phone:509-946-6124
Mailing Address - Fax:866-692-4493
Practice Address - Street 1:1305 MANSFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-946-6124
Practice Address - Fax:866-692-4493
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9650177Medicaid
Q71092Medicare UPIN