Provider Demographics
NPI:1225147101
Name:FAUCHER, KIMBERLY R (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:FAUCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490
Mailing Address - Country:US
Mailing Address - Phone:707-456-1100
Mailing Address - Fax:707-456-1101
Practice Address - Street 1:1155 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490
Practice Address - Country:US
Practice Address - Phone:707-456-1100
Practice Address - Fax:707-456-1101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74987207VG0400X
WAMD00036004207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4821FAOtherBLUE SHIELD
WA8232035Medicaid
WA0039592OtherLABOR & INDUSTRY
WAUS5553733OtherAETNA/USHC SPECIALIST
P00239584OtherRAILROAD MEDICARE
WA0039592OtherLABOR & INDUSTRY
WA8232035Medicaid