Individual
KIMBERLY LYNN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-4101
(253) 838-6418
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00042317
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171443
LIWA ST JOE MEDICAL
WA
01
—
2165MO
BSWA ST JOE MEDICAL
WA
05
—
8351884
—
WA
Enumeration date
06/06/2006
Last updated
03/20/2008
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