Provider Demographics
NPI:1780899856
Name:JAMES, KIMBLERY (LMP)
Entity type:Individual
Prefix:MRS
First Name:KIMBLERY
Middle Name:
Last Name:JAMES
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 1:4544 E BRUNNER RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-8517
Mailing Address - Country:US
Mailing Address - Phone:208-704-6676
Mailing Address - Fax:
Practice Address - Street 1:409 N ARGONNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2874
Practice Address - Country:US
Practice Address - Phone:509-924-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA208586OtherLABOR & INDUSTRIES