Provider Demographics
NPI:1184959090
Name:DUTHIE, KATHLEEN MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIA
Last Name:DUTHIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-624-9112
Mailing Address - Fax:509-624-1087
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-624-9112
Practice Address - Fax:509-624-1087
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25597OtherWASHINGTON LABOR AND INDUSTRY
WA8559965Medicaid
WA8559965Medicaid