=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104377050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHERINE KIM ARNP, PMHNP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2016
-----------------------------------------------------
Last Update Date | 01/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 NW 54TH ST STE 378
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-3575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-588-5578
-----------------------------------------------------
Fax | 206-374-2463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1417 NW 54TH ST STE 378
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-3575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-588-5578
-----------------------------------------------------
Fax | 206-374-2463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADULT PSYCHIATRIC NP
-----------------------------------------------------
Name | CATHERINE M KIM
-----------------------------------------------------
Credential | ARNP, PMHNP
-----------------------------------------------------
Telephone | 206-588-5578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP60222250
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------