Healthcare Provider Details

I. General information

NPI: 1033557616
Provider Name (Legal Business Name): JEANA DENISE KIMBALL ND, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 1315
SEATTLE WA
98101-1771
US

IV. Provider business mailing address

509 OLIVE WAY STE 1315
SEATTLE WA
98101-1771
US

V. Phone/Fax

Practice location:
  • Phone: 206-382-9977
  • Fax:
Mailing address:
  • Phone: 206-851-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000035
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number00000626
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: