Provider Demographics
NPI:1447247069
Name:KLEIVER, KATHLEEN F (MSN, ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:KLEIVER
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 SE 240TH ST
Mailing Address - Street 2:#201
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5124
Mailing Address - Country:US
Mailing Address - Phone:253-859-2273
Mailing Address - Fax:253-850-8894
Practice Address - Street 1:10024 SE 240TH ST
Practice Address - Street 2:#201
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:253-859-2273
Practice Address - Fax:253-850-8894
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623406Medicaid
WA9623406Medicaid
WA8857753Medicare PIN