MEDICARE: MRS. KIMBERLY A SPANGRUDE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	C-APN.0991964-C-NP	CO
2	363LF0000X	Family Nurse Practitioner	223145-4405	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	451870YS6E	OTHER	CO	MEDICARE PART B FOR LBN: OLATHE COMMUNITY CLINIC

General Provider Information

NPI Number	:	1013986710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY A SPANGRUDE FNP-C

Provider Business Mailing Address
First Line	:	2233 E. MAIN ST.
Second Line	:	BUSINESS OPTIONS MEDICAL BILLING
City	:	MONTROSE
State	:	CO
Zip	:	81401-3831
Country	:	US
Telephone Number	:	970-765-0810
Fax Number	:	970-497-8410

Provider Business Practice Location Address
First Line	:	3354 E RUTLAND PL
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5829
Country	:	US
Telephone Number	:	801-971-1739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	10/12/2018

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Directions to “ MRS. KIMBERLY A SPANGRUDE FNP-C” Practice Location

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