Provider Demographics
NPI:1891684734
Name:HART, KIMBERLY KELLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KELLY
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9918 236TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5615
Mailing Address - Country:US
Mailing Address - Phone:206-794-5634
Mailing Address - Fax:
Practice Address - Street 1:9918 236TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5615
Practice Address - Country:US
Practice Address - Phone:206-794-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach