KENNETH K BRODERICK (NPI# 1992217202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992217202 |
| Entity Type | Individual |
| Full Name | KENNETH K BRODERICK |
| Practice Address |
982 E Columbia Ave Ste 201 Colville WA 99114-3316 |
| Mailing Address |
165 E Hawthorne Ave Colville WA 99114-2629 |
| Practice Telephone | 5096855000 |
| Practice Fax Number | 5096845286 |
| Mailing Telephone | 5096844597 |
| Mailing Fax Number | 5096845286 |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
RN60039364 | WA | Nursing Service Providers |
| Street Address |
982 E COLUMBIA AVE STE 201 |
| City | COLVILLE |
| State | WA |
| Zip Code | 99114-3316 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730229709 | Carol H Leach | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114 | 2007-02-07 |
| 1205468857 | Brooke S Tabacco | Counselor | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2020-02-11 |
| 1629600994 | Glen E Potter | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2020-02-05 |
| 1982263786 | Doris A Garrett | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2019-06-06 |
| 1073084802 | Manfred E Mayer | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2018-12-05 |
| 1225527336 | Patrick William Diedrich | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2018-05-03 |
| 1104332246 | Caroline Louise Best | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-12-27 |
| 1861908998 | Joaquina Yanez Zipoli | Licensed Practical Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-12-27 |
| 1891200283 | James A Stryd | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-12-06 |
| 1578075883 | Kathleen J Bosch | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033774799 | Salamia Mikheyeva | Massage Therapist | 697 Gillette Rd., Colville, WA 99114 | 2019-05-07 |
| 1053897694 | Rochelle Diconti | Counselor | 358 E Birch Ave Ste 101, Colville, WA 99114 | 2018-07-17 |
| 1679073928 | Laurel Shull | Massage Therapist | 298 S. Main St., Suite 208, Colville, WA 99114 | 2018-02-13 |
| 1235638123 | Taylor Vanwicklen | Nurse's Aide | 165 E. Hawthorne Ave, Colville, WA 99114 | 2018-02-06 |
| 1932608833 | Sandra Ingram | Registered Nurse | 165 E. Hawthorne Avenue, Colville, WA 99114 | 2018-02-06 |
| 1831451350 | Catherine M Lochner | Occupational Therapist | 1366 Onion Creek Rd., Colville, WA 99114 | 2012-06-11 |
| 1245552215 | Georgia Rae Goot | Hearing Instrument Specialist | 519 S. Main St., Colville, WA 99114 | 2010-02-18 |
| 1801018619 | David W King | Counselor | 165 E Hawthorne Avenue, Colville, WA 99114 | 2007-05-02 |
| 1497976484 | Jack Darrell Esvelt | Dentist | 181 E 1st, Colville, WA 99114 | 2007-05-01 |
| 1679612766 | H Theresa Porter | Optometrist | 693 Hallerwood Way, Colville, WA 99114 | 2007-02-05 |
| Find all providers in zip 99114 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427556752 | Kathleen Stone | Registered Nurse | 165 E Hawthorne Ave, Colville, WA 99114-2629 | 2018-02-01 |
| 1649779976 | Peggy Vandegriffe | Registered Nurse | 165 E Hawthorne Ave, Colville, WA 99114-2629 | 2018-02-01 |
| 1891200283 | James A Stryd | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-12-06 |
| 1578075883 | Kathleen J Bosch | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-26 |
| 1861904104 | Lisa C Luiten | Registered Nurse | 165 E Hawthorne Ave, Colville, WA 99114-2629 | 2017-10-26 |
| 1588176895 | Lana L Davies | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-26 |
| 1831600717 | Grace K Fetters | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-18 |
| 1497266381 | Marcia L Macafee | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-18 |
| 1093226987 | Chad Mclain | Registered Nurse | 982 E Columbia Ave Ste 201, Colville, WA 99114-3316 | 2017-10-18 |
| 1376932111 | Heather Rae Day | Registered Nurse | 165 E Hawthorne Ave, Colville, WA 99114-2629 | 2015-01-16 |
| Find all providers in COLVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.