Healthcare Provider Details

I. General information

NPI: 1164082244
Provider Name (Legal Business Name): KIMBERLY M HARDWICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY M FOWLER

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

1204 N VERCLER RD STE 101
SPOKANE VALLEY WA
99216-1020
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61529
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61529
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: