Provider Demographics
NPI:1700683190
Name:JURGENS, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JURGENS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JULIUS
Other - Middle Name:
Other - Last Name:LUCIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1012 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1831
Mailing Address - Country:US
Mailing Address - Phone:360-223-3546
Mailing Address - Fax:
Practice Address - Street 1:1012 GROVER ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1831
Practice Address - Country:US
Practice Address - Phone:360-223-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator