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General NPI Number Information
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NPI Number | 1912447434
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Entity Type | Organization
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Legal Business Name | OFF THE GRID MIDWIFERY AND WOMEN'S HEALTH
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 6002 WESTGATE BLVD SUITES 270 & 274
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City | TACOMA
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State | WA
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Zip | 98406-2570
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Country | US
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Telephone | 253-509-2960
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Fax | 253-292-1045
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Provider Business Mailing Address
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Address Line | 6002 WESTGATE BLVD SUITE 120
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City | TACOMA
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State | WA
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Zip | 98406-2570
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Country | US
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Telephone | 253-509-2960
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Fax | 253-292-1045
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MRS. KATHRYN B JACKSON
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Credential | CNM, ARNP
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Telephone | 253-509-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP30003731
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License Number State | WA
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