Active NPI
Kimberly Lynn Funchess, PA
- Physician Assistant
- Poulsbo, WA
National Provider Identifier
1639159189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3343
- Practice address
- 19500 10TH Ave NE
Suite 100
Poulsbo, WA 98370-6553 - Phone
- (360) 598-7500
- Fax
- (360) 598-7505
- NPI assigned
- Jan 19, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3343 | AZ | Primary |
Addresses
Primary practice location
19500 10TH Ave NE
Suite 100
Poulsbo, WA 98370-6553
Mailing address
19500 10TH Ave NE
Suite 100
Poulsbo, WA 98370-6553
Phone (360) 598-7500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 985608 | Medicaid | AZ | |
| PA60322657 | Other | WA | WASHINGTON STATE LICENSE |
Other names 1
- Kimberly Wessel
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3343 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Arizona, LLC | Past | Accepting new patients | |
| Privia Medical Group Arizona, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Payson, AZ
- NPI 1740459700
-
- Family Medicine Physician
- Phoenix, AZ
- NPI 1760441141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550102400000",
"number": "1639159189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19500 10TH AVE NE",
"address_2": "SUITE 100",
"city": "POULSBO",
"state": "WA",
"postal_code": "983706553",
"telephone_number": "360-598-7500",
"fax_number": "360-598-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19500 10TH AVE NE",
"address_2": "SUITE 100",
"city": "POULSBO",
"state": "WA",
"postal_code": "983706553",
"telephone_number": "360-598-7500",
"fax_number": "360-598-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNCHESS",
"first_name": "KIMBERLY",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-19",
"last_updated": "2019-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "3343",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "985608",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE LICENSE",
"identifier": "PA60322657",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "WESSEL",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Poulsbo, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.