Healthcare Provider Details

I. General information

NPI: 1205987484
Provider Name (Legal Business Name): KIMBERLY GILMORE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

IV. Provider business mailing address

PO BOX 82318
KENMORE WA
98028-0318
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-5658
  • Fax:
Mailing address:
  • Phone: 206-854-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1506
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: