DR. KENNETH ANTHONY DIETRICH (NPI# 1245288752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245288752 |
| Entity Type | Individual |
| Full Name | DR. KENNETH ANTHONY DIETRICH |
| Credential | M.D., MBA |
| Practice Address |
600 E Main St Elma WA 98541-9560 |
| Practice Telephone | 3603462240 |
| Practice Fax Number | 3603462192 |
| Mailing Telephone | 3603462240 |
| Mailing Fax Number | 3603462192 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-04-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
27133 | WA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 314 Martin Luther King Jr Way, Suite 9, Tacoma, WA 984054250 | 2534031511 |
| Street Address |
600 E MAIN ST |
| City | ELMA |
| State | WA |
| Zip Code | 98541-9560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568099844 | Roy Dean Miller | Student in an Organized Health Care Education/Training Program | 600 E Main St, Elma, WA 98541-9560 | 2020-03-25 |
| 1467091702 | Britanie Lining | Physical Therapist | 600 E Main St, Elma, WA 98541-9560 | 2020-01-03 |
| 1083258859 | Joseph Lewis Mcfadden | Nurse Practitioner | 600 E Main St, Elma, WA 98541-9560 | 2019-11-04 |
| 1437701463 | Washington Orthopaedic Center, Inc, Ps | Orthopaedic Surgery | 600 E Main St, Elma, WA 98541-9560 | 2019-07-10 |
| 1801451273 | Patrick O'reilly | Physician Assistant | 600 E Main St, Elma, WA 98541-9560 | 2019-05-01 |
| 1417412537 | Sarah Carossino | Dietitian, Registered | 600 E Main St, Elma, WA 98541-9560 | 2019-02-02 |
| 1083183644 | Andrew J Burton | Pharmacist | 600 E Main St, Elma, WA 98541-9560 | 2018-11-13 |
| 1346726825 | Kaylyn Wayman | Nurse Practitioner | 600 E Main St, Elma, WA 98541 | 2018-07-17 |
| 1629582093 | Rebecca Elizabeth Bozeman | Physician Assistant | 600 E Main St, Elma, WA 98541-9560 | 2017-11-21 |
| 1043730021 | Grays Harbor County Public Hospital District No 1 Health Homes | Family Medicine | 600 E Main St, Elma, WA 98541-9560 | 2017-06-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962021444 | Rabab Cheema | Student in an Organized Health Care Education/Training Program | Summit Pacific Family Medicine, 600 E. Main Street, Elma, WA 98541 | 2020-04-14 |
| 1164087896 | Jamie Christina Talley | Massage Therapist | 201 S. 3rd Street, Elma, WA 98541 | 2019-05-08 |
| 1306359377 | Brandy L Hahn | Counselor | 308 E. Young St, Elma, WA 98541 | 2017-11-13 |
| 1205349412 | Charli Loretta Jankord | Massage Therapist | 201 South 3rd Street, Elma, WA 98541 | 2017-11-09 |
| 1588194013 | Janel Lynn Lewis | Counselor | 575 E. Main Suite C, Elma, WA 98541 | 2017-06-18 |
| 1962931139 | Cole Robert Johnson | Counselor | 575 E Main Street, Elma, WA 98541 | 2017-06-09 |
| 1922323880 | Kimberly Ann Peters | Counselor | 308 E. Young St., Elma, WA 98541 | 2010-04-05 |
| 1467776112 | Amy L Lystad | Counselor | 114 S. 5th St., Elma, WA 98541 | 2010-03-24 |
| 1649593336 | Maja C Ballew | Massage Therapist | 434 West Main Street, Elma, WA 98541 | 2010-03-09 |
| 1659603066 | Cristiana Maria Franklin | Counselor | 308 E. Young, Elma, WA 98541 | 2010-02-10 |
| Find all providers in zip 98541 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689637563 | Martha Alice Mccravey | Pediatrics | 314 Martin Way, Tacoma, WA 98405-4269 | 2006-04-10 |
| 1306378278 | Pliceliany Perez | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2017-03-30 |
| 1184057267 | Ashley Deline Calahan | Pediatrics | 1344 Wintergreen Ln Ne, Bainbridge Island, WA 98110 | 2013-08-13 |
| 1972846079 | Whitney Elizabeth Kopp | Pediatrics | 101 W 8th Ave, Spokane, WA 99204-2307 | 2013-03-27 |
| 1710276761 | Emily Berkman | Pediatrics | 4800 Sand Point Way Ne, A-5950, Seattle, WA 98105 | 2011-03-30 |
| 1255652731 | Ashley T Jones | Pediatrics | 317 Martin Luther King Jr Way, Mary Bridge Children's Hospital, Tacoma, WA 98405 | 2010-06-18 |
| 1003077025 | Leslie Ann Dervan | Pediatrics | 4800 Sand Point Way Ne, Mb.10.620, Seattle, WA 98105-3901 | 2008-06-23 |
| 1861651929 | Silvia Hartmann | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2008-06-04 |
| 1538338975 | Amelie Olga-marie Von Saint Andre - Von Arnim | Pediatrics | 4800 Sand Point Way Ne, M/s W-8866, Seattle, WA 98105-3901 | 2008-02-28 |
| 1992907208 | Derk August Mueller | Pediatrics | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-05-31 |
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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.