Provider Demographics
NPI:1053798546
Name:SPECTRUM CARE, PLLC
Entity type:Organization
Organization Name:SPECTRUM CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY 'KIMMER'
Authorized Official - Middle Name:VERLYNN
Authorized Official - Last Name:COLLISON-RIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP-BC WOCN CAM
Authorized Official - Phone:4252-104-1187
Mailing Address - Street 1:5908 149TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-210-4187
Mailing Address - Fax:425-361-1704
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:117
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:425-210-4187
Practice Address - Fax:425-361-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty