1619221793 NPI number — MRS. KIMBERLY SHOWERS FOSS MS, LGC

Table of content: MRS. KIMBERLY SHOWERS FOSS MS, LGC (NPI 1619221793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619221793 NPI number — MRS. KIMBERLY SHOWERS FOSS MS, LGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSS
Provider First Name:
KIMBERLY
Provider Middle Name:
SHOWERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHOWERS
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CGC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619221793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 SAND POINT WAY NE
Provider Second Line Business Mailing Address:
OC.9.850
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-987-5211
Provider Business Mailing Address Fax Number:
206-987-2495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
OC.9.850
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-987-5211
Provider Business Practice Location Address Fax Number:
206-987-2495
Provider Enumeration Date:
10/29/2012

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1619221793 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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