Provider Demographics
NPI:1851303465
Name:ALEXANDER, KIMBERLY GAYLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GAYLE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:GAYLE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
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:509-252-9602
Mailing Address - Fax:
Practice Address - Street 1:212 E CENTRAL
Practice Address - Street 2:SUITE 440
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-252-9602
Practice Address - Fax:509-489-5110
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007238363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648601Medicaid