Provider Demographics
NPI:1720297237
Name:CORK, KATHRYN AMY (ND)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:AMY
Last Name:CORK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3045
Mailing Address - Country:US
Mailing Address - Phone:206-781-1763
Mailing Address - Fax:
Practice Address - Street 1:149 NW 84TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3045
Practice Address - Country:US
Practice Address - Phone:206-781-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001363175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath