MEDICARE: MRS. KIMBERLY MARIE HIRST RN

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	163W00000X	Registered Nurse	0115281	CO

General Provider Information

NPI Number	:	1255678579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MARIE HIRST RN

Provider Business Mailing Address
First Line	:	4110 HOOKER ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1622
Country	:	US
Telephone Number	:	720-849-9632
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 HOOKER ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1622
Country	:	US
Telephone Number	:	720-849-9632
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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