Terri Lynn Kilbourne, MA 00004895

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA 00004895 Issued in WA

Practice address

1710 Railroad Street
Enumclaw Day Spa
Enumclaw, WA 98022

Phone

(360) 825-5755

NPI assigned

Apr 10, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Terri Lynn Kilbourne Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365552000000",
    "number": "1508209420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62408 FOREST GLEN WAY E",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980228088",
            "telephone_number": "360-663-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 RAILROAD STREET",
            "address_2": "ENUMCLAW DAY SPA",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "98022",
            "telephone_number": "360-825-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILBOURNE",
        "first_name": "TERRI",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MA 00004895",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-10",
        "last_updated": "2013-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA 00004895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRI",
            "last_name": "KILBOURNE",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "MA 00004895",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Anthony Carroll Jordan, PA-S
• Roberta Jowell, LPN
• Michael A Kay, DDS
• Gouhar Yusuof Khan, M.D.
• Joyce Wangui Kibui, PHARMD
• King County Anesthesia Associates PLLC
• Corina Marie Kingdon
• Christopher Parco Koontz, DDS
• Jeremy Parco Koontz, DMD
• Shalesa Marie Kovash, L.M.P

• Specialist in Enumclaw, WA
• Providers in Enumclaw, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.