Provider Demographics
NPI:1902057250
Name:AUSTIN, KATHRYN JANE (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JANE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3130
Mailing Address - Country:US
Mailing Address - Phone:509-386-6985
Mailing Address - Fax:509-876-4623
Practice Address - Street 1:534 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3130
Practice Address - Country:US
Practice Address - Phone:509-386-6985
Practice Address - Fax:509-876-4623
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60039710363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA96593431093103Medicaid