MEDICARE: KIMBERLY THIES DINEEN 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

General Provider Information

NPI Number	:	1891534855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY THIES DINEEN PA-C

Provider Business Mailing Address
First Line	:	8401 S CHAMBERS RD
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-3276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12905 W 40TH AVE STE 515
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-2794
Country	:	US
Telephone Number	:	303-665-2603
Fax Number	:

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

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	03/02/2026

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Directions to “ KIMBERLY THIES DINEEN PA-C” Practice Location

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