Healthcare Provider Details

I. General information

NPI: 1811808751
Provider Name (Legal Business Name): AUSTIN JAMES KIMBALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S PERRY ST
CASTLE ROCK CO
80104-1919
US

IV. Provider business mailing address

1442 WANDERING WAY
CASTLE ROCK CO
80109-3693
US

V. Phone/Fax

Practice location:
  • Phone: 719-309-2684
  • Fax:
Mailing address:
  • Phone: 360-920-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: