Healthcare Provider Details

I. General information

NPI: 1871190835
Provider Name (Legal Business Name): WOMENS MOBILE MEDICAL - LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 09/02/2025
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11318 BRIDGEPORT WAY SW STE A
LAKEWOOD WA
98499-3054
US

IV. Provider business mailing address

11318 BRIDGEPORT WAY SW STE A
LAKEWOOD WA
98499-3054
US

V. Phone/Fax

Practice location:
  • Phone: 253-380-8905
  • Fax: 253-353-7334
Mailing address:
  • Phone: 253-380-8905
  • Fax: 253-353-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MICHELLE KIRKWOOD
Title or Position: CEO, MEDICAL DIRECTOR, ARNP
Credential: ARNP, WHNP-BC
Phone: 253-380-8905