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General NPI Number Information
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NPI Number | 1447333885
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Entity Type | Individual
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Provider Name | KIMBERLY A EDWARDS LMP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1107 OAK ST
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City | MILTON
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State | WA
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Zip | 98354-9234
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Country | US
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Telephone | 253-896-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 S SHERIDAN AVE
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City | TACOMA
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State | WA
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Zip | 98405-3556
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00018397
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License Number State | WA
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