Healthcare Provider Details

I. General information

NPI: 1710066287
Provider Name (Legal Business Name): KIMBERLY STATLER BENNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY DAWN STATLER MD

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8289 E LOWRY BLVD
DENVER CO
80230-7256
US

IV. Provider business mailing address

8289 E LOWRY BLVD
DENVER CO
80230-7256
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2828
  • Fax: 303-321-7171
Mailing address:
  • Phone: 303-321-2828
  • Fax: 303-321-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberDR0053849
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberDR0053849
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: