Provider Demographics
NPI:1447397096
Name:WALTON, KIMBERLY I (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:I
Last Name:WALTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SEWARD PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4247
Mailing Address - Country:US
Mailing Address - Phone:206-725-8800
Mailing Address - Fax:206-722-5210
Practice Address - Street 1:7500 SEWARD PARK AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4247
Practice Address - Country:US
Practice Address - Phone:206-725-8800
Practice Address - Fax:206-722-5210
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00127914363L00000X
WAAP30005019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624644Medicaid
WAGAB12988Medicare PIN
WA9624644Medicaid
WAGAB12987Medicare PIN
WAGAB12985Medicare PIN
WAGAB12986Medicare PIN
WAGAB12984Medicare PIN