Healthcare Provider Details

I. General information

NPI: 1003137498
Provider Name (Legal Business Name): KIM C STEPHENS LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 UCB
BOULDER CO
80309-5001
US

IV. Provider business mailing address

1900 WARDENBURG DRIVE 119 UCB
BOULDER CO
80309-5001
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5432
  • Fax: 303-492-1341
Mailing address:
  • Phone: 303-492-5432
  • Fax: 303-492-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0002621
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: