Provider Demographics
NPI:1093583387
Name:MACINTOSH, KIMBERLY D (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2500 W SIMS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2234
Mailing Address - Country:US
Mailing Address - Phone:360-385-0610
Mailing Address - Fax:360-379-8259
Practice Address - Street 1:2500 W SIMS WAY STE 300
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2234
Practice Address - Country:US
Practice Address - Phone:360-385-0610
Practice Address - Fax:360-379-8259
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60764670163WH0200X, 163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice