MEDICARE: KIMBERLY J. DICKEY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	OP00001620	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124004692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY J. DICKEY DO

Provider Business Mailing Address
First Line	:	21616 76TH AVE W
Second Line	:	#205
City	:	EDMONDS
State	:	WA
Zip	:	98026-7512
Country	:	US
Telephone Number	:	425-640-4810
Fax Number	:	425-640-4998

Provider Business Practice Location Address
First Line	:	21616 76TH AVE W
Second Line	:	#205
City	:	EDMONDS
State	:	WA
Zip	:	98026-7512
Country	:	US
Telephone Number	:	425-640-4810
Fax Number	:	425-640-4998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY J. DICKEY DO” Practice Location

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