Provider Demographics
NPI:1891927000
Name:KO, KATHERINE AMANDA (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMANDA
Last Name:KO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:AMANDA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 112TH AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2945
Mailing Address - Country:US
Mailing Address - Phone:425-968-5948
Mailing Address - Fax:425-385-0985
Practice Address - Street 1:2105 112TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2945
Practice Address - Country:US
Practice Address - Phone:425-968-5948
Practice Address - Fax:425-385-0985
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60213651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health