Provider Demographics
NPI:1669950937
Name:OVERLY, KATHLEEN LOUISE (DNP)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:OVERLY
Suffix:
Gender:F
Credentials:DNP
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Mailing Address - Street 1:1708 YAKIMA AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5309
Mailing Address - Country:US
Mailing Address - Phone:253-382-8181
Mailing Address - Fax:253-382-8174
Practice Address - Street 1:1708 YAKIMA AVE STE 310
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5309
Practice Address - Country:US
Practice Address - Phone:253-382-8181
Practice Address - Fax:253-382-8174
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60864065363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2113203Medicaid