Healthcare Provider Details

I. General information

NPI: 1013277474
Provider Name (Legal Business Name): LARA KIM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 05/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S SUITE 330
FEDERAL WAY WA
98003-8727
US

IV. Provider business mailing address

34503 9TH AVE S SUITE 330
FEDERAL WAY WA
98003-8727
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-3695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60285347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: