Doctor Name: | KERRY LEXENE VANWINKLE-KOEPPEN |
NPI Number: | 1902041254 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00025185 |
Business Practice Address: | 1600 Roosevelt Ave Ste A Mount Vernon, WA - 982732646 |
Business Phone Number: | 3604280304 |
Business Fax Number: | 3604280968 |
Mailing Address: | 1600 Roosevelt Ave Ste A, MOUNT VERNON |
State: | WA |
Postal Code: | 982732646 |
Phone Number: | 3604280304 |
Fax Number: | 3604280968 |
NPI Enumeration Date: | 12/15/2008 |
NPI Last Update Date: | 12/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA00025185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |