MEDICARE: MRS. KIMBERLEY ANNE BURNS APRN,BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP 30007986	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8906798	OTHER	WA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0289355	OTHER	WA	L&I
3	0301476	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1023012416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLEY ANNE BURNS APRN,BC

Provider Business Mailing Address
First Line	:	1617 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4930
Country	:	US
Telephone Number	:	253-274-7504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4930
Country	:	US
Telephone Number	:	253-274-7504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/11/2016

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