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: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9362 TEDDY LN STE 106
LONE TREE CO
80124-2871
US

IV. Provider business mailing address

5445 DTC PKWY STE 1130
GREENWOOD VILLAGE CO
80111-3038
US

V. Phone/Fax

Practice location:
  • Phone: 720-749-5599
  • Fax: 720-403-8182
Mailing address:
  • Phone: 720-749-5599
  • Fax: 720-925-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: