Provider Demographics
NPI:1902038516
Name:HAMILTON, KAYLYN HEATHER (LMP)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:HEATHER
Last Name:HAMILTON
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 1:13601 W CRITTER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-8513
Mailing Address - Country:US
Mailing Address - Phone:360-286-9682
Mailing Address - Fax:
Practice Address - Street 1:3105 WHEATON WAY STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3460
Practice Address - Country:US
Practice Address - Phone:360-813-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60041598171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor