Healthcare Provider Details

I. General information

NPI: 1649628413
Provider Name (Legal Business Name): KATHERINE GRACE KAMM EICKHOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE GRACE KAMM PA-C

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 NE 128TH ST STE 400
KIRKLAND WA
98034-3029
US

IV. Provider business mailing address

7683 SE 27TH ST STE 254
MERCER ISLAND WA
98040-2804
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4810
  • Fax: 425-899-4811
Mailing address:
  • Phone: 425-999-3580
  • Fax: 425-999-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60680690
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: