Provider Demographics
NPI:1730229428
Name:TINSLEY, MOLLY J (LMP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:J
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1602 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3806
Mailing Address - Country:US
Mailing Address - Phone:253-820-6918
Mailing Address - Fax:
Practice Address - Street 1:10100 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2302
Practice Address - Country:US
Practice Address - Phone:253-820-6918
Practice Address - Fax:253-983-9474
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist