Active NPI
Kirk Dawson, D.O.
- Family Medicine Physician
- Yelm, WA
National Provider Identifier
1902850803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OP00001279
- Practice address
- 202 Cullens St NW
Yelm, WA 98597-9417 - Phone
- (360) 458-7761
- Fax
- (360) 458-6612
- NPI assigned
- May 22, 2006
- Sex
- Male
- 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 Medicine Physician | 207Q00000X | OP00001279 | WA | Primary |
Addresses
Primary practice location
202 Cullens St NW
Yelm, WA 98597-9417
Mailing address
4570 Avery LN SE
Ste C-180
Lacey, WA 98503
Phone (360) 528-7122
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 72333 | Other | WA | L&I |
| 1073360 | Medicaid | WA | |
| DA7849 | Other | WA | REGENCE |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OP00001279 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580947200000",
"number": "1902850803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4570 AVERY LN SE",
"address_2": "STE C-180",
"city": "LACEY",
"state": "WA",
"postal_code": "98503",
"telephone_number": "360-528-7122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 CULLENS ST NW",
"city": "YELM",
"state": "WA",
"postal_code": "985979417",
"telephone_number": "360-458-7761",
"fax_number": "360-458-6612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAWSON",
"first_name": "KIRK",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2020-02-06",
"certification_date": "2020-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "OP00001279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "72333",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1073360",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "DA7849",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yelm, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.