Healthcare Provider Details

I. General information

NPI: 1245198878
Provider Name (Legal Business Name): KIMBERLY L LATHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N WHEELING ST,
AURORA CO
80045
US

IV. Provider business mailing address

332 MORA PL
ERIE CO
80516-8956
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1633048
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: