Healthcare Provider Details

I. General information

NPI: 1962347179
Provider Name (Legal Business Name): KIMBERLY K FIRESTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 LEFTHAND CIR
LONGMONT CO
80501-6782
US

IV. Provider business mailing address

1801 LEFTHAND CIR
LONGMONT CO
80501-6782
US

V. Phone/Fax

Practice location:
  • Phone: 888-611-0870
  • Fax: 888-714-4996
Mailing address:
  • Phone: 888-611-0870
  • Fax: 888-714-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: