Healthcare Provider Details

I. General information

NPI: 1467461905
Provider Name (Legal Business Name): KIMBERLY BULLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NORTHEAST
SEATTLE WA
98745-5005
US

IV. Provider business mailing address

4800 SAND POINT WAY NORTHEAST
SEATTLE WA
98745-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2174
  • Fax: 206-987-2639
Mailing address:
  • Phone: 206-987-2174
  • Fax: 206-987-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP60378739
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: