Healthcare Provider Details

I. General information

NPI: 1689148090
Provider Name (Legal Business Name): BERNADETTE N KIMEMIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PACIFIC AVE STE 400
TACOMA WA
98402-4381
US

IV. Provider business mailing address

6210 147TH PL SE
EVERETT WA
98208-9387
US

V. Phone/Fax

Practice location:
  • Phone: 253-300-8453
  • Fax:
Mailing address:
  • Phone: 407-452-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60920611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: