Healthcare Provider Details

I. General information

NPI: 1053625814
Provider Name (Legal Business Name): KATHI PAULYNE LLOYD MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EVERGREEN LN
ELMA WA
98541-9337
US

IV. Provider business mailing address

101 EVERGREEN LN
ELMA WA
98541-9337
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-2786
  • Fax:
Mailing address:
  • Phone: 360-482-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: