Healthcare Provider Details

I. General information

NPI: 1871051300
Provider Name (Legal Business Name): KATHRYN ELIZABETH ROONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATY ROONEY MD

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26401 PACIFIC HWY S STE 101
DES MOINES WA
98198-9247
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 206-870-3590
  • Fax:
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61269547
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number61-1123386
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-1301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: