MEDICARE: MS. KIMBERLY RACINE PA-C

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	363A00000X	Physician Assistant	1481	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00944762	OTHER	CO	MEDICARE RAILROAD CARRIER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598737975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY RACINE PA-C

Provider Business Mailing Address
First Line	:	3850 N GRANT AVE STE 200
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538
Country	:	US
Telephone Number	:	970-624-5170
Fax Number	:	970-669-7521

Provider Business Practice Location Address
First Line	:	3850 N GRANT AVE STE 200
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-8431
Country	:	US
Telephone Number	:	970-624-5170
Fax Number	:	970-669-7521

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/08/2021

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