Healthcare Provider Details

I. General information

NPI: 1366190712
Provider Name (Legal Business Name): KERRY E CALAVANO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W FRONT ST STE A
PORT ANGELES WA
98362-2609
US

IV. Provider business mailing address

240 W FRONT ST STE A
PORT ANGELES WA
98362-2609
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7891
  • Fax: 360-452-8087
Mailing address:
  • Phone: 360-452-7891
  • Fax: 360-452-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11014565
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61685262
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN11014565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: