Provider Demographics
NPI:1821639485
Name:LOVETT, KIM A
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:LOVETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:LOVETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98385-0349
Mailing Address - Country:US
Mailing Address - Phone:425-691-0315
Mailing Address - Fax:
Practice Address - Street 1:7224 PACIFIC HIGHWAY EAST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98385
Practice Address - Country:US
Practice Address - Phone:253-220-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00059348164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse