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General NPI Number Information
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NPI Number | 1043557333
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Entity Type | Organization
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Legal Business Name | FREELAND PRIMARY CARE PLLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 5577 VANBARR PL
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City | FREELAND
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State | WA
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Zip | 98249-9555
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Country | US
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Telephone | 360-331-3343
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Fax | 360-331-3373
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Provider Business Mailing Address
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Address Line | PO BOX 935
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City | FREELAND
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State | WA
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Zip | 98249-0935
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Country | US
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Telephone | 360-331-3343
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Fax | 360-331-3373
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KIMBERLY JOHNSON
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Credential |
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Telephone | 360-331-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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