MEDICARE: KIMSEY SELF MNT

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	133NN1002X	Nutrition Education Nutritionist		CO

General Provider Information

NPI Number	:	1265982151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMSEY SELF MNT

Provider Business Mailing Address
First Line	:	2259 S JOSEPHINE ST
Second Line	:	#303
City	:	DENVER
State	:	CO
Zip	:	80210-4846
Country	:	US
Telephone Number	:	512-970-3532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2259 S JOSEPHINE ST
Second Line	:	#303
City	:	DENVER
State	:	CO
Zip	:	80210-4846
Country	:	US
Telephone Number	:	512-970-3532
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “ KIMSEY SELF MNT” Practice Location

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