Provider Demographics
NPI:1669023826
Name:HUSSEY, KIMBRELY KAYLEAN
Entity Type:Individual
Prefix:
First Name:KIMBRELY
Middle Name:KAYLEAN
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBRELY
Other - Middle Name:
Other - Last Name:FENNERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2722 NE 392ND AVE
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-9682
Mailing Address - Country:US
Mailing Address - Phone:503-358-0159
Mailing Address - Fax:
Practice Address - Street 1:2722 NE 392ND AVE
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-9682
Practice Address - Country:US
Practice Address - Phone:503-358-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider