Provider Demographics
NPI:1033557616
Name:KIMBALL, JEANA DENISE (ND, MPH)
Entity Type:Individual
Prefix:DR
First Name:JEANA
Middle Name:DENISE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:ND, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY STE 1315
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1771
Mailing Address - Country:US
Mailing Address - Phone:206-851-7300
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1315
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1771
Practice Address - Country:US
Practice Address - Phone:206-382-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000035175F00000X
WA00000626175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath