Healthcare Provider Details

I. General information

NPI: 1780661694
Provider Name (Legal Business Name): KATHRYN JACKSON ARNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN BOYLE ARNP CNM

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALASKAN WAY S STE 200 # 9452
SEATTLE WA
98104
US

IV. Provider business mailing address

6002 WESTGATE BLVD STE 120
TACOMA WA
98406-2580
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 253-228-7623
  • Fax: 306-400-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30003731
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30003731
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number025801 RN00121312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: