Provider Demographics
NPI:1922151612
Name:GMEINER, KJERSTEN (MD)
Entity Type:Individual
Prefix:
First Name:KJERSTEN
Middle Name:
Last Name:GMEINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10030 SW 210TH ST
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6584
Mailing Address - Country:US
Mailing Address - Phone:206-463-3671
Mailing Address - Fax:206-463-3613
Practice Address - Street 1:10030 SW 210TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6584
Practice Address - Country:US
Practice Address - Phone:206-463-3671
Practice Address - Fax:206-463-3613
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53440207Q00000X
WAMD00039154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA332441OtherSTATE L&I
WA8275638Medicaid
WAH53461Medicare UPIN
WAGAB26240Medicare PIN
WA8275638Medicaid