Provider Demographics
NPI:1083128524
Name:SHIPLEY, KIMBERLY ALICE (DNP/FNP; ARNP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALICE
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:DNP/FNP; ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-0015
Mailing Address - Country:US
Mailing Address - Phone:509-480-9317
Mailing Address - Fax:
Practice Address - Street 1:409 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3114
Practice Address - Country:US
Practice Address - Phone:509-575-2949
Practice Address - Fax:509-575-5743
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP607775692083X0100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine