Healthcare Provider Details

I. General information

NPI: 1497907406
Provider Name (Legal Business Name): KIMBERLY SUZANNE SMITS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUZANNE ANDERSON ARNP

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 333RD ST STE 150
FEDERAL WAY WA
98003-7391
US

IV. Provider business mailing address

200 S 333RD ST STE 150
FEDERAL WAY WA
98003-7391
US

V. Phone/Fax

Practice location:
  • Phone: 253-275-6030
  • Fax: 253-946-0428
Mailing address:
  • Phone: 253-275-6030
  • Fax: 253-946-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60039600
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00167980
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: