Active NPI
Kristina Dawn Clyburn, PHARMD
- Pharmacist
- Seattle, WA
National Provider Identifier
1467705459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60284760
- Practice address
- 2117 N 53Rd St
Apt B
Seattle, WA 98103 - Phone
- (304) 920-1026
- NPI assigned
- Oct 16, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH60284760 | WA | Primary |
| Pharmacist | 183500000X | RP0007693 | WV |
Addresses
Primary practice location
2117 N 53Rd St
Apt B
Seattle, WA 98103
Mailing address
1959 NE Pacific St
Seattle, WA 98195
Phone (304) 920-1026
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 Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH60284760 | WA | MD | Pharmacist |
| RP0007693 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350345600000",
"number": "1467705459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98195",
"telephone_number": "304-920-1026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2117 N 53RD ST",
"address_2": "APT B",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98103",
"telephone_number": "304-920-1026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYBURN",
"first_name": "KRISTINA",
"middle_name": "DAWN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-16",
"last_updated": "2012-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60284760",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0007693",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.