Provider Demographics
NPI:1043525652
Name:KIMBLE, EMILY LANE (CNP, ARNP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LANE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:CNP, ARNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JOY
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 37TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1609
Practice Address - Country:US
Practice Address - Phone:206-461-6957
Practice Address - Fax:206-461-7810
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.349120163W00000X
CA95021864163W00000X
OHCOA.11840-NP363LF0000X
CA95000144363LF0000X
WAAP61105809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034011Medicare PIN
OH2034012Medicare PIN
OHH131010Medicare PIN
OH3127940Medicaid
OHH131012Medicare PIN
OHH131011Medicare PIN