1124149026 NPI number — MS. KIMBERLY 'KIMMER' VERLYNN COLLISON-RIS MSN, ARNP, WOCN

Table of content: (NPI 1083040901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124149026 NPI number — MS. KIMBERLY 'KIMMER' VERLYNN COLLISON-RIS MSN, ARNP, WOCN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLISON-RIS
Provider First Name:
KIMBERLY 'KIMMER'
Provider Middle Name:
VERLYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, ARNP, WOCN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLISON-RIS
Provider Other First Name:
KIMMER
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, ARNP, WOCN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124149026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16425 48TH AVE W
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-210-4187
Provider Business Mailing Address Fax Number:
425-361-1704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16425 48TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-210-4187
Provider Business Practice Location Address Fax Number:
425-361-1704
Provider Enumeration Date:
04/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30006553 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SF0001X , with the licence number: AP30006553 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SH1100X , with the licence number: AP30006553 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SM0705X , with the licence number: AP30006553 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP2800X , with the licence number: AP30006553 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SR0400X , with the licence number: A , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 911950338 . This is a "ID # ALL OTHER INSURANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911950338 . This is a "TAX ID # & BLUE CROSS #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5783CO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".