=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376220434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OFFICE OF KIMBERLY JEFFREY DNP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2023
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 N 12TH ST UNIT T1000
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-254-2470
-----------------------------------------------------
Fax | 970-965-0032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3150 N 12TH ST UNIT T1000
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-254-2470
-----------------------------------------------------
Fax | 970-965-0032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | KIMBERLY JEFFREY
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 970-254-2470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------