KATY L MODLIN (NPI# 1073965851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073965851 |
| Entity Type | Individual |
| Full Name | KATY L MODLIN |
| Credential | D.O. |
| Practice Address |
9040a Jackson Ave Joint Base Lewis Mcchord WA 98431-5638 |
| Mailing Address |
9040a Jackson Ave Joint Base Lewis Mcchord WA 98431-0001 |
| Practice Telephone | 4026700611 |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2020-10-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 88717 | MT | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 1771 | NE | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 1771 | NE | Allopathic & Osteopathic Physicians |
| Street Address |
9040A JACKSON AVE |
| City | JOINT BASE LEWIS MCCHORD |
| State | WA |
| Zip Code | 98431-5638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336747716 | Melissa Stahl | Occupational Therapist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-10-16 |
| 1043832090 | Ryan Michael Brock | Pharmacist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-05-13 |
| 1205457900 | Yang Qu | Physician Assistant | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-05-04 |
| 1275195877 | Michael C Saenz | Licensed Practical Nurse | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2019-07-03 |
| 1154892792 | Nicholas James Wankum | Physical Therapist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-12-07 |
| 1942775184 | Rachel Nell Dyal | Nutritionist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-10-03 |
| 1861998346 | Isaac Ingersoll | General Practice | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-04-03 |
| 1184124687 | Ketan Mehta | General Practice | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-02-20 |
| 1104286582 | Andrew Zilka | Physician Assistant | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2016-02-29 |
| 1164881520 | Aundrea Kastl | General Practice | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-4504 | 2016-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629694864 | Fishers Landing Internal Medicine | Dermatology | 1405 Se 164th Ave Ste 101, Vancouver, WA 98683-9644 | 2020-06-23 |
| 1417599374 | Dermatology Solutions | Dermatology | 8503 W Clearwater Ave Ste B, Kennewick, WA 99336-3100 | 2019-10-11 |
| 1588164925 | Northwest Pediatric Dermatology, Pllc | Dermatology | 703 Lilly Rd Ne Ste 105, Olympia, WA 98506-5191 | 2018-02-12 |
| 1255858247 | Ame Phitwong | Dermatology | 21727 76th Ave W Ste H, Edmonds, WA 98026-7549 | 2017-08-29 |
| 1467879320 | Jayasri Iyer | Dermatology | 9924 Ne 185th St Ste 215, Bothell, WA 98011-3504 | 2014-03-27 |
| 1164869459 | Kaley Myer | Dermatology | 304 W Bay Dr Nw Ste 301, Olympia, WA 98502-4957 | 2013-05-28 |
| 1093158305 | Erica Shantha Tarabadkar | Dermatology | 850 Republican Street, Brotman Room 242, Uw Medical Center At Lake Union, Seattle, WA 98109 | 2013-04-17 |
| 1871835322 | Jason Lee Meeker | Dermatology | 2622 S. Meridian, Puyallup, WA 98373-1500 | 2013-03-22 |
| 1578839494 | Carolina Andrea Simunovic | Dermatology | 1959 Ne Pacific St Rm Bb-1353, Box 356524, Seattle, WA 98195-6524 | 2012-03-25 |
| 1184999260 | April Schachtel | Dermatology | 1660 S Columbian Way Va Puget Sound Health Care System, General Internal Medicine Clinic, Seattle, WA 98108 | 2012-03-21 |
| Find all providers with the same taxonomy | ||||
| City | JOINT BASE LEWIS MCCHORD |
| Zip Code | 98431 |
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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.