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General NPI Number Information
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NPI Number | 1356847198
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Entity Type | Individual
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Provider Name | KIMBERLY DEPPISCH DO
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Gender | Female
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 605 E HOLLAND AVE STE 101
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City | SPOKANE
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State | WA
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Zip | 99218-1246
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Country | US
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Telephone | 509-342-3010
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Fax | 509-755-5376
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Provider Business Mailing Address
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Address Line | PO BOX 5299 MS: 820-5-PCO
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City | TACOMA
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State | WA
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Zip | 98415-0299
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 58.030193
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OP61164059
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License Number State | WA
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