1285604298 NPI number — KIMBERLEE MICHELLE WURTH ARNP

Table of content: KIMBERLEE MICHELLE WURTH ARNP (NPI 1285604298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285604298 NPI number — KIMBERLEE MICHELLE WURTH ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WURTH
Provider First Name:
KIMBERLEE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DER KOLK
Provider Other First Name:
KIMBERLEE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285604298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 S. 72ND AVENUE
Provider Second Line Business Mailing Address:
PACIFIC CREST FAMILY MEDICINE
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-972-1818
Provider Business Mailing Address Fax Number:
509-248-8291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 S. 72ND AVENUE
Provider Second Line Business Practice Location Address:
PACIFIC CREST FAMILY MEDICINE
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1818
Provider Business Practice Location Address Fax Number:
509-248-8291
Provider Enumeration Date:
01/23/2006

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:  15755 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP60237028 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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