Physician Compare National (NPI:1346360658)

HEALTHCARE PROVIDER: KIM EVANGELINE FUNDERBURK MSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1346360658
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456583558
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140403001174
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FUNDERBURK
	Individual professional last name
Provider First Name	KIM
	Individual professional first name
Provider Middle Name	EVANGELINE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	401 W MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	WALLA WALLA
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	993622837
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5092402644
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y