Healthcare Provider Details

I. General information

NPI: 1841337110
Provider Name (Legal Business Name): TRACI A. KIMBALL MD CWSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACI M. ANGELICA

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 RALSTON RD UNIT 3
ARVADA CO
80004-4974
US

IV. Provider business mailing address

10050 RALSTON RD UNIT 3
ARVADA CO
80004-4974
US

V. Phone/Fax

Practice location:
  • Phone: 303-940-1611
  • Fax: 303-432-2296
Mailing address:
  • Phone: 303-940-1611
  • Fax: 303-432-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR49586
License Number StateCO
# 10
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code246ZB0301X
TaxonomyBiomedical Engineer
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCO
# 13
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR49586
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: