Healthcare Provider Details

I. General information

NPI: 1275793796
Provider Name (Legal Business Name): MOMS ARE US AND KIDS 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N DENNIS ST
KENNEWICK WA
99336-3129
US

IV. Provider business mailing address

PO BOX 6762
KENNEWICK WA
99336-0640
US

V. Phone/Fax

Practice location:
  • Phone: 509-586-6248
  • Fax: 509-586-7928
Mailing address:
  • Phone: 509-586-6248
  • Fax: 509-586-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30003677
License Number StateWA

VIII. Authorized Official

Name: JEAN A KIMERLING
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 509-551-9981