Healthcare Provider Details

I. General information

NPI: 1174486435
Provider Name (Legal Business Name): KIMBERLY LAVON HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BRAXTON

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 M.L.K. JR WAY
TACOMA WA
98405
US

IV. Provider business mailing address

2804 336TH ST S
ROY WA
98580-8689
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP70031162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: