Healthcare Provider Details

I. General information

NPI: 1700524493
Provider Name (Legal Business Name): KATHLEEN MAGDALES GOMEZ DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 27TH ST W
UNIVERSITY PLACE WA
98466-2723
US

IV. Provider business mailing address

1610 LAFAYETTE ST P.O BOX 881009
STEILACOOM WA
98388-1307
US

V. Phone/Fax

Practice location:
  • Phone: 253-900-1605
  • Fax: 253-900-1612
Mailing address:
  • Phone: 253-414-1983
  • Fax: 253-234-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70041331
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61021853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: