Provider Demographics
NPI:1407211683
Name:THOMAS, KIMBERLY J (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 WESTGATE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2572
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:253-779-8364
Practice Address - Street 1:6002 WESTGATE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2572
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:253-779-8364
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP605923393363L00000X
WAAP 60592393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054505Medicaid