Healthcare Provider Details

I. General information

NPI: 1689195646
Provider Name (Legal Business Name): KIMBERLY MAHOWALD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY WILKINSON NP-C

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E HAMPDEN AVE
DENVER CO
80224-3012
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 303-925-4960
  • Fax: 303-925-4960
Mailing address:
  • Phone: 480-855-2224
  • Fax: 480-398-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06170809
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0002265-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: