Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP 30007986 | WA |
NPI | 1023012416 |
---|---|
Provider Name | Mrs. Kimberley Anne Burns |
First Address | Tacoma, WA 98405-4930 |
Second Address | Tacoma, WA 98405-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 11/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0289355 | L&I (01) | WA |
0301476 | STATE L&I (01) | WA |
G8906798 | MEDICARE (01) | WA |