MEDICARE: DR. KIMBERLEY A MAXWELL D.O.

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	2084P0800X	Psychiatry Physician	OP6102077	WA
2	207Q00000X	Family Medicine Physician	OP61020077	WA
3	207Q00000X	Family Medicine Physician	DR.0053095	CO

General Provider Information

NPI Number	:	1619222692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLEY A MAXWELL D.O.

Provider Business Mailing Address
First Line	:	1035 116TH AVE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4604
Country	:	US
Telephone Number	:	425-688-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 ROCKVILLE PIKE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-0001
Country	:	US
Telephone Number	:	301-295-4000
Fax Number	:

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	02/19/2026

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