Healthcare Provider Details

I. General information

NPI: 1144064015
Provider Name (Legal Business Name): KIMBERLY HA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 WALL ST STE 2D
EVERETT WA
98201-3942
US

IV. Provider business mailing address

1316 WALL ST STE 2D
EVERETT WA
98201-3942
US

V. Phone/Fax

Practice location:
  • Phone: 425-340-3500
  • Fax: 425-642-0022
Mailing address:
  • Phone: 425-340-3500
  • Fax: 425-642-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61353947
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70061772
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: