MEDICARE: KIMBERLY RANDALL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0186699	CO

General Provider Information

NPI Number	:	1588268650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY RANDALL RN

Provider Business Mailing Address
First Line	:	1441 RED MICA WAY
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7437
Country	:	US
Telephone Number	:	719-639-8396
Fax Number	:

Provider Business Practice Location Address
First Line	:	7707 FOREST VALLEY LOOP
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5649
Country	:	US
Telephone Number	:	719-639-8396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	04/23/2025

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