Healthcare Provider Details

I. General information

NPI: 1023012416
Provider Name (Legal Business Name): KIMBERLEY ANNE BURNS APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY ANNE GRAY APRN,BC

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 S J ST
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1617 S J ST
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7504
  • Fax:
Mailing address:
  • Phone: 253-274-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP 30007986
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: