Healthcare Provider Details

I. General information

NPI: 1508512815
Provider Name (Legal Business Name): KATE ALYCA WILD CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATE BLVD STE 274
TACOMA WA
98406-2571
US

IV. Provider business mailing address

2489 SE TUCCI PL
PORT ORCHARD WA
98367-9614
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-8939
  • Fax:
Mailing address:
  • Phone: 360-649-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW61198999
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW61198999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: