Provider Demographics
NPI:1164796298
Name:COY, KIMBERLY ANNE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:COY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 WHEATON WAY
Mailing Address - Street 2:SUITE Q
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3566
Mailing Address - Country:US
Mailing Address - Phone:360-373-5883
Mailing Address - Fax:360-479-5815
Practice Address - Street 1:4020 WHEATON WAY
Practice Address - Street 2:SUITE Q
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3566
Practice Address - Country:US
Practice Address - Phone:360-373-5883
Practice Address - Fax:360-479-5815
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00000742237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist