MEDICARE: KIMBERLY CARLSON PA-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	363A00000X	Physician Assistant	PA.0006253	CO

General Provider Information

NPI Number	:	1265054431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CARLSON PA-C

Provider Business Mailing Address
First Line	:	2519 LELARAY ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2404
Country	:	US
Telephone Number	:	727-254-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	8580 SCARBOROUGH DR STE 225
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7586
Country	:	US
Telephone Number	:	719-531-5400
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	01/11/2024

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Directions to “ KIMBERLY CARLSON PA-C” Practice Location

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