Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 60292818 | WA |
N | 208000000X | Pediatrician | MD 60564662 | WA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD60564662 | WA |
NPI | 1043586969 |
---|---|
Provider Name | Dr. Katherine Kenningham |
First Address | Gig Harbor, WA 98335-8160 |
Second Address | Tacoma, WA 98405-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 27/10/2021 |