Provider Demographics
NPI:1619221793
Name:FOSS, KIMBERLY SHOWERS (MS, LGC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHOWERS
Last Name:FOSS
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SHOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:9800 SAND POINT WAY NE
Mailing Address - Street 2:OC.9.850
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:209-987-5211
Mailing Address - Fax:206-987-2495
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:OC.9.850
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:209-987-5211
Practice Address - Fax:206-987-2495
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619221793Medicaid