Individual provider Active NPI

Karin Elke Kimbrough, LMP

  • Specialist
  • Bothell, WA
National Provider Identifier
1528071917
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MA00003322 Issued in WA
Practice address
20527 Greening Rd
Bothell, WA 98012-9683
Phone
(425) 486-2157
Fax
(206) 284-2556
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MA00003322 WA Primary

Addresses

Primary practice location

20527 Greening Rd
Bothell, WA 98012-9683

Mailing address

20527 Greening Rd
Bothell, WA 98012-9683
Phone (425) 486-2157

Other identifiers 1

IdentifierTypeStateIssuer
MA00003322OtherWAMASSAGE PRACTITIONER

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

LicenseStateTypeSpecialty
MA00003322WAMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528071917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20527 GREENING RD",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980129683",
            "telephone_number": "425-486-2157",
            "fax_number": "206-284-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20527 GREENING RD",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980129683",
            "telephone_number": "425-486-2157",
            "fax_number": "206-284-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "KARIN",
        "middle_name": "ELKE",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00003322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE PRACTITIONER",
            "identifier": "MA00003322",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.