Healthcare Provider Details

I. General information

NPI: 1760842017
Provider Name (Legal Business Name): KACIE CHATWOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

13201 LINDEN AVE N APT 506
SEATTLE WA
98133-7536
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-9105
  • Fax:
Mailing address:
  • Phone: 406-855-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number146380
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: