Healthcare Provider Details

I. General information

NPI: 1619502879
Provider Name (Legal Business Name): KEMBER LEIGH MCGOWAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE MS:X3-CAR
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE MS:X3-CAR
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-1111
  • Fax:
Mailing address:
  • Phone: 206-341-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61062794
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61062794
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60758904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: