MEDICARE: KIMBERLY NORTH NP

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	363LG0600X	Gerontology Nurse Practitioner	APN.0993843-NP	CO
2	363L00000X	Nurse Practitioner	APN.0993843-NP	CO

General Provider Information

NPI Number	:	1144707506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NORTH NP

Provider Business Mailing Address
First Line	:	PO BOX 9049
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-9049
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W SOUTH BOULDER RD STE 216
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2089
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:	303-442-1073

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	09/27/2024

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Directions to “ KIMBERLY NORTH NP” Practice Location

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