Provider Demographics
NPI:1821075433
Name:HORVATH, KIMBERLY ELIZABETH (PAC CM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:HORVATH
Suffix:
Gender:F
Credentials:PAC CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 WESTGATE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2572
Mailing Address - Country:US
Mailing Address - Phone:253-761-2244
Mailing Address - Fax:
Practice Address - Street 1:6002 WESTGATE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2572
Practice Address - Country:US
Practice Address - Phone:253-761-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
WA025211 PA10001876363A00000X
WAPA10001876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0270556OtherL&I
WA8345050Medicaid
WAG8895789OtherMEDICARE
WA1055128Medicaid
WA5413H0OtherREGENCE