Provider Demographics
NPI:1396431649
Name:GAVIN, KRISTEN (DO)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 S MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3423
Mailing Address - Country:US
Mailing Address - Phone:360-767-6300
Mailing Address - Fax:
Practice Address - Street 1:931 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3423
Practice Address - Country:US
Practice Address - Phone:360-767-6300
Practice Address - Fax:360-767-6320
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL61659896390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program