Provider Demographics
NPI:1073622064
Name:HIMES, BARBARA H (RD, CDE)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:H
Last Name:HIMES
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 W POLE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9486
Mailing Address - Country:US
Mailing Address - Phone:360-384-0860
Mailing Address - Fax:
Practice Address - Street 1:1610 GROVER ST
Practice Address - Street 2:SUITE D-10
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-354-1333
Practice Address - Fax:360-354-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7600174Medicaid
WAGAB26437Medicare ID - Type UnspecifiedMEDICARE ID #