Healthcare Provider Details

I. General information

NPI: 1083128524
Provider Name (Legal Business Name): KIMBERLY ALICE SHIPLEY DNP/FNP; ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S 12TH AVE
YAKIMA WA
98902-3114
US

IV. Provider business mailing address

PO BOX 2069
SELAH WA
98942-0015
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-2949
  • Fax: 509-575-5743
Mailing address:
  • Phone: 509-480-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberAP60777569
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60777569
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: