Healthcare Provider Details

I. General information

NPI: 1669733838
Provider Name (Legal Business Name): KIMBERLY NICHOLE ROSS NP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY NICHOLE FLAKE NP, PMHNP

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 BRIAR VILLAGE PT STE 320
COLORADO SPRINGS CO
80920-7905
US

IV. Provider business mailing address

9475 BRIAR VILLAGE PT STE 320
COLORADO SPRINGS CO
80920-7905
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 719-220-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000864
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0998307-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998307-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16683
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR868155
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: