Provider Demographics
NPI:1467461905
Name:BULLER, KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BULLER
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 1:4800 SAND POINT WAY NORTHEAST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98745-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-2174
Mailing Address - Fax:206-987-2639
Practice Address - Street 1:4800 SAND POINT WAY NORTHEAST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98745-5005
Practice Address - Country:US
Practice Address - Phone:206-987-2174
Practice Address - Fax:206-987-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAARNP60378739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3171672OtherARNP LICENSE
WA60378739OtherARNP60378739