Healthcare Provider Details

I. General information

NPI: 1972380822
Provider Name (Legal Business Name): KIMBERLY ROYAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OLSEN ST
HENDERSON NV
89011-3006
US

IV. Provider business mailing address

1400 WEWATTA ST STE 350
DENVER CO
80202-5553
US

V. Phone/Fax

Practice location:
  • Phone: 702-747-4657
  • Fax: 702-747-4657
Mailing address:
  • Phone: 866-808-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN48510
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: