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General NPI Number Information
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NPI Number | 1174305601
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Entity Type | Organization
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Legal Business Name | TRACI A. KIMBALL MD PC
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 4798 S ACOMA ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-6541
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Country | US
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Telephone | 303-940-1611
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Fax | 303-432-2296
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Provider Business Mailing Address
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Address Line | 10050 RALSTON RD UNIT 3
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City | ARVADA
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State | CO
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Zip | 80004-4974
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Country | US
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Telephone | 303-940-1611
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Fax | 303-432-2296
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | TRACI A. KIMBALL
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Credential | MD
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Telephone | 720-557-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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Taxonomy #3
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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Taxonomy #4
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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Taxonomy #5
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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Taxonomy #6
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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Taxonomy #7
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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Taxonomy #8
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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Taxonomy #9
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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Taxonomy #10
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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Taxonomy #11
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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Taxonomy #12
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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Taxonomy #13
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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Taxonomy #14
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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Taxonomy #15
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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