Provider Demographics
NPI:1770656472
Name:KACOROSKI, KIMBERLEY A (ND)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:A
Last Name:KACOROSKI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12236 NE 67TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8546
Mailing Address - Country:US
Mailing Address - Phone:425-822-4927
Mailing Address - Fax:
Practice Address - Street 1:12236 NE 67TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8546
Practice Address - Country:US
Practice Address - Phone:425-828-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025205NT00007537175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3715KAOtherREGENCE BLUE SHIELD