Provider Demographics
NPI:1649628413
Name:EICKHOFF, KATHERINE GRACE KAMM (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRACE KAMM
Last Name:EICKHOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:GRACE
Other - Last Name:KAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7683 SE 27TH ST STE 254
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2804
Mailing Address - Country:US
Mailing Address - Phone:425-999-3580
Mailing Address - Fax:425-999-3122
Practice Address - Street 1:12039 NE 128TH ST STE 400
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3029
Practice Address - Country:US
Practice Address - Phone:425-899-4810
Practice Address - Fax:425-899-4811
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AM0700X
WAPA60680690363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical