Provider Demographics
NPI:1285604298
Name:WURTH, KIMBERLEE MICHELLE (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:MICHELLE
Last Name:WURTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:MICHELLE
Other - Last Name:VAN DER KOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:311 S. 72ND AVENUE
Mailing Address - Street 2:PACIFIC CREST FAMILY MEDICINE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-972-1818
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:311 S. 72ND AVENUE
Practice Address - Street 2:PACIFIC CREST FAMILY MEDICINE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-972-1818
Practice Address - Fax:509-248-8291
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15755363LF0000X
WAAP60237028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily