Provider Demographics
NPI:1740819895
Name:DE ASIS, KATHLEEN GAYLE (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GAYLE
Last Name:DE ASIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:903 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1697
Practice Address - Country:US
Practice Address - Phone:360-435-6525
Practice Address - Fax:360-435-2634
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP61395766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics