Provider Demographics
NPI:1225245061
Name:ALLEN, KIMBERLY GAIL (ND, LMP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GAIL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 LARSON LN NW
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9699
Mailing Address - Country:US
Mailing Address - Phone:360-710-3320
Mailing Address - Fax:360-698-0183
Practice Address - Street 1:3636 NW BYRON ST
Practice Address - Street 2:SUITE #102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8541
Practice Address - Country:US
Practice Address - Phone:360-698-0494
Practice Address - Fax:360-698-0183
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014936171W00000X
WANT00001342175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194693OtherLABOR & INDUSTRIES