Provider Demographics
NPI:1922487743
Name:RUSH, KIM RICHARDSON (CDMS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RICHARDSON
Last Name:RUSH
Suffix:
Gender:M
Credentials:CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 140TH AVE NE
Mailing Address - Street 2:STE E110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1862
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:
Practice Address - Street 1:2515 140TH AVE NE
Practice Address - Street 2:STE E110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1862
Practice Address - Country:US
Practice Address - Phone:425-644-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator