MEDICARE: KIMBERLY NICHOLE ROSS NP, PMHNP-BC

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	APN.0998307-NP	CO
2	363LF0000X	Family Nurse Practitioner	0000864	CO
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0998307-NP	CO
4	363LF0000X	Family Nurse Practitioner	R868155	MS
5	363LF0000X	Family Nurse Practitioner	16683	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	16683	OTHER	TN	APN LICENSE
3	R868155	OTHER	MS	LICENSE

General Provider Information

NPI Number	:	1669733838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NICHOLE ROSS NP, PMHNP-BC

Provider Business Mailing Address
First Line	:	5445 DTC PKWY STE 1130
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3038
Country	:	US
Telephone Number	:	720-749-5599
Fax Number	:	720-925-5897

Provider Business Practice Location Address
First Line	:	9362 TEDDY LN STE 106
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2871
Country	:	US
Telephone Number	:	720-749-5599
Fax Number	:	720-403-8182

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	12/22/2025

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Directions to “ KIMBERLY NICHOLE ROSS NP, PMHNP-BC” Practice Location

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