Provider Demographics
NPI:1730156308
Name:LAVALLEY, KATHERINE (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LAVALLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:L
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1112 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4048
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:253-404-1352
Practice Address - Street 1:1112 6TH AVE
Practice Address - Street 2:200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4040
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:253-404-1352
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202641OtherLABOR & INDUSTRIES
1021BROtherREGENCE
WA9646613Medicaid
Q53907Medicare UPIN
8856590Medicare ID - Type UnspecifiedMEDICARE
WA9646613Medicaid