Provider Demographics
NPI:1700524493
Name:GOMEZ, KATHLEEN MAGDALES (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MAGDALES
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 LAFAYETTE ST
Mailing Address - Street 2:P.O BOX 881009
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1307
Mailing Address - Country:US
Mailing Address - Phone:253-414-1983
Mailing Address - Fax:253-234-9567
Practice Address - Street 1:8404 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2723
Practice Address - Country:US
Practice Address - Phone:253-900-1605
Practice Address - Fax:253-900-1612
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN61021853163W00000X
WAAP70041331363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse