Active NPI
Kathleen Gayle Tabaquin Boado, NP
- Family Nurse Practitioner
- Maple Valley, WA
National Provider Identifier
1043846207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP-61050697
- Practice address
- 26913 223Rd LN SE
Maple Valley, WA 98038-7479 - Phone
- (808) 397-6119
- NPI assigned
- Mar 19, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP-61050697 | WA | Primary |
Addresses
Primary practice location
26913 223Rd LN SE
Maple Valley, WA 98038-7479
Mailing address
26913 223Rd LN SE
Maple Valley, WA 98038-7479
Phone (808) 397-6119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP-61050697 | WA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584576000000",
"number": "1043846207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26913 223RD LN SE",
"city": "MAPLE VALLEY",
"state": "WA",
"postal_code": "980387479",
"telephone_number": "808-397-6119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26913 223RD LN SE",
"city": "MAPLE VALLEY",
"state": "WA",
"postal_code": "980387479",
"telephone_number": "808-397-6119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOADO",
"first_name": "KATHLEEN GAYLE",
"middle_name": "TABAQUIN",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-19",
"last_updated": "2020-03-19",
"certification_date": "2020-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP-61050697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Valley, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.