Kimberly Christine Clark, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

VA61186782 Issued in WA

Practice address

205 Pine Ave
Snohomish, WA 98290-2539

Phone

(360) 563-0223

Fax

(360) 563-0418

NPI assigned

Feb 16, 2022

Last updated

Feb 16, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1609521814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6",
            "city": "SULTAN",
            "state": "WA",
            "postal_code": "982940006",
            "telephone_number": "425-399-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PINE AVE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982902539",
            "telephone_number": "360-563-0223",
            "fax_number": "360-563-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "CHRISTINE",
        "credential": "CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "WA",
            "license": "VA61186782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Joan Chisholm, PT
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• Patrick Arnold Chonzena, D.C.
• Patricia Chu
• Shashi Lynn Churchill, AU.D.
• Samanntha Clark, RDN
• Classic Chiropractic Clinic LLC
• Classic Chiropractic Clinic, LLC
• Classic Massage Clinic, PLLC
• Classic Massage Collective, PLLC

• Pharmacy Technician in Snohomish, WA
• Providers in Snohomish, WA by specialty
• Pharmacy Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.