Provider Demographics
NPI:1831464015
Name:LEDEBOER, KAREE L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KAREE
Middle Name:L
Last Name:LEDEBOER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KAREE
Other - Middle Name:L
Other - Last Name:KIMBERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:13414 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2759
Practice Address - Country:US
Practice Address - Phone:509-624-2326
Practice Address - Fax:509-747-3040
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00163532364S00000X
WAAP60277763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017457Medicaid
WAP01106238OtherRAILROAD MEDICARE
WA0307239OtherLABOR & INDUSTRIES
WAP01106238OtherRAILROAD MEDICARE