Provider Demographics
NPI:1417181835
Name:MORRISON, KIM (LMP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MORRISON
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 1:12932 SE KENT KANGLEY RD # 438
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:253-630-6614
Mailing Address - Fax:253-630-6624
Practice Address - Street 1:12932 SE KENT KANGLEY RD # 438
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7940
Practice Address - Country:US
Practice Address - Phone:253-630-6614
Practice Address - Fax:253-630-6624
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist