Provider Demographics
NPI:1093176364
Name:BLAIR, KIMBERLY TAYLOR ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY TAYLOR
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:K. TAYLOR
Other - Middle Name:ANN
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:877-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60156422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse