Provider Demographics
NPI:1871190835
Name:WOMENS MOBILE MEDICAL - LLC
Entity Type:Organization
Organization Name:WOMENS MOBILE MEDICAL - LLC
Other - Org Name:THE WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-380-8905
Mailing Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3054
Mailing Address - Country:US
Mailing Address - Phone:253-380-8905
Mailing Address - Fax:253-353-7334
Practice Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3054
Practice Address - Country:US
Practice Address - Phone:253-380-8905
Practice Address - Fax:253-353-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135058Medicaid