Provider Demographics
NPI:1609183003
Name:MCALLISTER, KIMBERLY BRADLEY (KIMBERLY MCALLISTER)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BRADLEY
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:KIMBERLY MCALLISTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 DAYTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3716
Mailing Address - Country:US
Mailing Address - Phone:206-619-7005
Mailing Address - Fax:
Practice Address - Street 1:9025 DAYTON AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3716
Practice Address - Country:US
Practice Address - Phone:206-619-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60171958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist