Healthcare Provider Details

I. General information

NPI: 1346019742
Provider Name (Legal Business Name): KIMBERLY KRISTIN DURIED KASSAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY KRISTIN HAHN

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 CHANDELLE RD
CASTLE ROCK CO
80104-7730
US

IV. Provider business mailing address

738 CHANDELLE RD
CASTLE ROCK CO
80104-7730
US

V. Phone/Fax

Practice location:
  • Phone: 720-471-8079
  • Fax:
Mailing address:
  • Phone: 720-471-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN.0994636-CNS
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAPN.0994636-CNS
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: