Healthcare Provider Details

I. General information

NPI: 1417003146
Provider Name (Legal Business Name): KATHALEEN RANEE BRIGGS EARLY RD CD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY EARLY

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DRIVE YAKIMA VALLEY MEMORIAL HOSPITAL
YAKIMA WA
98902
US

IV. Provider business mailing address

4201 STORM AVE
YAKIMA WA
98908
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8101
  • Fax: 509-577-5011
Mailing address:
  • Phone: 509-480-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001367
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: