Healthcare Provider Details

I. General information

NPI: 1588758924
Provider Name (Legal Business Name): TIM WHITWORTH LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 WEST HOOD PLACE SUITE 103
KENNEWICK WA
99336
US

IV. Provider business mailing address

7105 WEST HOOD PLACE SUITE 103
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-374-4719
  • Fax: 509-374-3873
Mailing address:
  • Phone: 509-374-4719
  • Fax: 509-374-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00021695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: