Healthcare Provider Details

I. General information

NPI: 1821075433
Provider Name (Legal Business Name): KIMBERLY ELIZABETH HORVATH PAC CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATE BLVD STE 230
TACOMA WA
98406-2572
US

IV. Provider business mailing address

6002 WESTGATE BLVD STE 230
TACOMA WA
98406-2572
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-2244
  • Fax:
Mailing address:
  • Phone: 253-761-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025211 PA10001876
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10001876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: