Provider Demographics
NPI:1386774578
Name:KB FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:KB FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:K BURNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAETZEL-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-438-3029
Mailing Address - Street 1:408 LILLY RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6954
Mailing Address - Country:US
Mailing Address - Phone:360-438-3029
Mailing Address - Fax:360-438-8585
Practice Address - Street 1:408 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6954
Practice Address - Country:US
Practice Address - Phone:360-438-3029
Practice Address - Fax:360-438-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001314207Q00000X, 261QH0100X
WAAP30006758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39827Medicare ID - Type Unspecified