Individual
MS. KATHRYN THENA MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11511 CANTERWOOD BLVD STE 205, GIG HARBOR, WA 98332-5818
(253) 530-2663
Mailing address
3620 JOSEPH SIEWICK DR, STE 100, FAIRFAX, VA 22033-1757
(253) 530-2663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001717
VA
363A00000X
Physician Assistant
PA10005153
WA
363AS0400X
Surgical Physician Assistant
PA10005153
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0251995
STATE L&I
WA
05
—
2003416
—
WA
Enumeration date
02/26/2007
Last updated
01/26/2021
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