Provider Demographics
NPI:1295962496
Name:FEHSENFELD, KATHERINE HARTER (PA-C,MAC,LAC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HARTER
Last Name:FEHSENFELD
Suffix:
Gender:F
Credentials:PA-C,MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DENNIS ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5459
Mailing Address - Country:US
Mailing Address - Phone:360-754-6367
Mailing Address - Fax:
Practice Address - Street 1:150 DENNIS ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5459
Practice Address - Country:US
Practice Address - Phone:360-754-6367
Practice Address - Fax:360-754-6429
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000725171100000X
WAPA 10001848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8935590Medicare PIN