Provider Demographics
NPI:1740645928
Name:ATKINSON, KAYLA (LMP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WHITLEY ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9455
Mailing Address - Country:US
Mailing Address - Phone:253-363-1544
Mailing Address - Fax:
Practice Address - Street 1:301 WHITLEY ST NW
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9455
Practice Address - Country:US
Practice Address - Phone:253-363-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60590665390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program