Healthcare Provider Details

I. General information

NPI: 1487893509
Provider Name (Legal Business Name): LYNN JANET KIMBALL P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE SUITE 310
BOULDER CO
80303-1080
US

IV. Provider business mailing address

25 BRISTLECONE WAY
BOULDER CO
80304-0412
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-2913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number59118
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number59118
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: