Healthcare Provider Details

I. General information

NPI: 1245686948
Provider Name (Legal Business Name): KARENA LYNN WHITWORTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARENA LYNN ROUNSAVILLE MD

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/09/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S SUITE 401
RENTON WA
98055-5738
US

IV. Provider business mailing address

3915 TALBOT RD S SUITE 401
RENTON WA
98055-5738
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax: 425-656-5395
Mailing address:
  • Phone: 425-228-3440
  • Fax: 425-656-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60668457
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60870282
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: