Healthcare Provider Details

I. General information

NPI: 1114049392
Provider Name (Legal Business Name): KIM SHARP RN, MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM EVANS

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 NORTH WELCOME SLOUGH
CATHLAMET WA
98612-0693
US

IV. Provider business mailing address

PO BOX 693
CATHLAMET WA
98612-0693
US

V. Phone/Fax

Practice location:
  • Phone: 360-849-4033
  • Fax: 360-849-4033
Mailing address:
  • Phone: 360-849-4033
  • Fax: 360-849-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30006862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: