Provider Demographics
NPI:1346434669
Name:WHITE, KIMBERLY (LMP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1867
Mailing Address - Country:US
Mailing Address - Phone:206-251-0761
Mailing Address - Fax:
Practice Address - Street 1:12400 E MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2559
Practice Address - Country:US
Practice Address - Phone:206-901-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist