Provider Demographics
NPI:1871691261
Name:EVANS, KIMBERLY CHRISTIAN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:CHRISTIAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:OUTLOOK
Mailing Address - State:WA
Mailing Address - Zip Code:98938-1340
Mailing Address - Country:US
Mailing Address - Phone:509-837-2989
Mailing Address - Fax:509-305-7044
Practice Address - Street 1:1120 SO 4TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1120
Practice Address - Country:US
Practice Address - Phone:509-837-2600
Practice Address - Fax:509-837-2291
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0211056OtherL & I