Healthcare Provider Details

I. General information

NPI: 1952703886
Provider Name (Legal Business Name): KIMBERLY LEE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY COOPER ARNP

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

720 8TH AVE S
SEATTLE WA
98104-3032
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3768
  • Fax:
Mailing address:
  • Phone: 425-788-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60503739
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00169050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: