=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962755710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KITSAP CLINIC OF NATURAL MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2012
-----------------------------------------------------
Last Update Date | 01/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 SCOTT AVE STE E
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98310-4874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-475-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1146
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. KATHERINE BARKSHIRE
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 360-475-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | NT 00001209
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------