Provider Demographics
NPI:1023012416
Name:BURNS, KIMBERLEY ANNE (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:BURNS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:MISS
Other - First Name:KIMBERLEY
Other - Middle Name:ANNE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,BC
Mailing Address - Street 1:1617 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7504
Mailing Address - Fax:
Practice Address - Street 1:1617 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 30007986363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906798OtherMEDICARE
WA0289355OtherL&I
WA0301476OtherSTATE L&I