Provider Demographics
NPI:1659992063
Name:FIELD, KIMBERLY WILLIS (RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:WILLIS
Last Name:FIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2237
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-5052
Mailing Address - Country:US
Mailing Address - Phone:360-490-8703
Mailing Address - Fax:253-459-6165
Practice Address - Street 1:3124 S 19TH ST STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2433
Practice Address - Country:US
Practice Address - Phone:253-792-6166
Practice Address - Fax:253-459-6165
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00074898163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Multi-Specialty