Provider Demographics
NPI:1427728906
Name:LINDQUIST, KIMBERLY M (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15563 PECOTA PL
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5150
Mailing Address - Country:US
Mailing Address - Phone:509-961-3849
Mailing Address - Fax:509-853-1082
Practice Address - Street 1:1446 SPAULDING AVE STE 301
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4720
Practice Address - Country:US
Practice Address - Phone:507-737-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61188875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2188122Medicaid
WA0444478OtherLABOR AND INDUSTRIES