Healthcare Provider Details

I. General information

NPI: 1003664624
Provider Name (Legal Business Name): OFF THE GRID MIDWIFERY & HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 S JUNETT ST STE B
TACOMA WA
98409-6480
US

IV. Provider business mailing address

PO BOX 294
BURLEY WA
98322-0294
US

V. Phone/Fax

Practice location:
  • Phone: 360-633-9146
  • Fax: 306-400-2735
Mailing address:
  • Phone: 253-509-2960
  • Fax: 306-400-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN JACKSON
Title or Position: CEO
Credential: CNM, ARNP
Phone: 253-509-2960