Provider Demographics
NPI:1144897968
Name:COSTLEY, KATELYN DANIELLE (LM, CPM, MSM)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:DANIELLE
Last Name:COSTLEY
Suffix:
Gender:F
Credentials:LM, CPM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0343
Mailing Address - Country:US
Mailing Address - Phone:805-404-8371
Mailing Address - Fax:
Practice Address - Street 1:10613 SW 138TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-3332
Practice Address - Country:US
Practice Address - Phone:805-404-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61098063176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife