MEDICARE: KIMBERLY ANNE MYERS F10220007

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.0988139-NP	CO

General Provider Information

NPI Number	:	1962112664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE MYERS F10220007

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-449-5122
Fax Number	:	414-815-5105

Provider Business Practice Location Address
First Line	:	940 WORTHINGTON CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1840
Country	:	US
Telephone Number	:	970-221-2273
Fax Number	:

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

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/04/2022

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