Healthcare Provider Details

I. General information

NPI: 1851303465
Provider Name (Legal Business Name): KIMBERLY GAYLE ALEXANDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY GAYLE ERICKSON ARNP

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E CENTRAL SUITE 440
SPOKANE WA
99208
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-9602
  • Fax: 509-489-5110
Mailing address:
  • Phone: 509-252-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30007238
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: