Active NPI
Kimberly Marie Reisen
- Specialist
- Gig Harbor, WA
National Provider Identifier
1104145432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 60100431
- Practice address
- 2601 Jahn Ave NW
Suite a-7
Gig Harbor, WA 98335-8900 - Phone
- (253) 857-6500
- Fax
- (253) 857-2225
- NPI assigned
- May 26, 2010
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA 60100431 | WA | Primary |
Addresses
Primary practice location
2601 Jahn Ave NW
Suite a-7
Gig Harbor, WA 98335-8900
Mailing address
2601 Jahn Ave NW
Suite a-7
Gig Harbor, WA 98335-8900
Phone (253) 857-6500
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 60100431 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274832000000",
"number": "1104145432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 JAHN AVE NW",
"address_2": "SUITE A-7",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983358900",
"telephone_number": "253-857-6500",
"fax_number": "253-857-2225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 JAHN AVE NW",
"address_2": "SUITE A-7",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983358900",
"telephone_number": "253-857-6500",
"fax_number": "253-857-2225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISEN",
"first_name": "KIMBERLY",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-26",
"last_updated": "2010-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA 60100431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gig Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.