Provider Demographics
NPI:1124149026
Name:COLLISON-RIS, KIMBERLY 'KIMMER' VERLYNN (MSN, ARNP, WOCN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY 'KIMMER'
Middle Name:VERLYNN
Last Name:COLLISON-RIS
Suffix:
Gender:F
Credentials:MSN, ARNP, WOCN
Other - Prefix:MS
Other - First Name:KIMMER
Other - Middle Name:V
Other - Last Name:COLLISON-RIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, ARNP, WOCN
Mailing Address - Street 1:16425 48TH AVE W
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037
Mailing Address - Country:US
Mailing Address - Phone:425-210-4187
Mailing Address - Fax:425-361-1704
Practice Address - Street 1:16425 48TH AVE W
Practice Address - Street 2:SUITE 215
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037
Practice Address - Country:US
Practice Address - Phone:425-210-4187
Practice Address - Fax:425-361-1704
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006553363LF0000X, 364SF0001X, 364SH1100X, 364SM0705X, 364SP2800X
WAA364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911950338OtherID # ALL OTHER INSURANCE
WA911950338OtherTAX ID # & BLUE CROSS #
WA5783COOtherREGENCE BLUE SHIELD
WA5783COOtherREGENCE BLUE SHIELD
WA911950338OtherID # ALL OTHER INSURANCE