Provider Demographics
NPI:1497907406
Name:SMITS, KIMBERLY SUZANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:SMITS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUZANNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 S 333RD ST
Mailing Address - Street 2:STE 150
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7391
Mailing Address - Country:US
Mailing Address - Phone:253-275-6030
Mailing Address - Fax:253-946-0428
Practice Address - Street 1:200 S 333RD ST
Practice Address - Street 2:STE 150
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7391
Practice Address - Country:US
Practice Address - Phone:253-275-6030
Practice Address - Fax:253-946-0428
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00167980163W00000X
WAAP60039600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0242140OtherSTATE L&I
WA9659087Medicaid
WA8949812OtherSTATE CRIME VICTIM
WA8949812OtherSTATE CRIME VICTIM
WAG8877278Medicare PIN