Healthcare Provider Details

I. General information

NPI: 1124149026
Provider Name (Legal Business Name): KIMBERLY 'KIMMER' VERLYNN COLLISON-RIS MSN, ARNP, WOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMMER V COLLISON-RIS MSN, ARNP, WOCN

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16425 48TH AVE W SUITE 215
LYNNWOOD WA
98037
US

IV. Provider business mailing address

16425 48TH AVE W SUITE 215
LYNNWOOD WA
98037
US

V. Phone/Fax

Practice location:
  • Phone: 425-210-4187
  • Fax: 425-361-1704
Mailing address:
  • Phone: 425-210-4187
  • Fax: 425-361-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006553
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP30006553
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License NumberAP30006553
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAP30006553
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License NumberAP30006553
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code364SR0400X
TaxonomyRehabilitation Clinical Nurse Specialist
License NumberA
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: