Active NPI
Elizabeth Davis Kilmer, PHD
- Clinical Psychologist
- Kirkland, WA
National Provider Identifier
1053903864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY61101025
- Practice address
- 12025 115TH Ave NE Ste 215
Kirkland, WA 98034-6943 - Phone
- (206) 895-5939
- NPI assigned
- Feb 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY61101025 | WA | Primary |
Addresses
Primary practice location
12025 115TH Ave NE Ste 215
Kirkland, WA 98034-6943
Mailing address
12025 115TH Ave NE
Building D Ste 215
Kirkland, WA 98034-6943
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PY61101025 | Other | WA | PSYCHOLOGIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY61101025 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621209600000",
"number": "1053903864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12025 115TH AVE NE",
"address_2": "BUILDING D STE 215",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980346943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12025 115TH AVE NE STE 215",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980346943",
"telephone_number": "206-895-5939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILMER",
"first_name": "ELIZABETH",
"middle_name": "DAVIS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-03",
"last_updated": "2021-05-17",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY61101025",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "PY61101025",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.