Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209.008453 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 990154 | CO |
NPI | 1003117516 |
---|---|
Provider Name | Kimberly Ann Johnson |
First Address | Glenwood Spgs, CO 81601-4227 |
Second Address | Glenwood Spgs, CO 81601-4227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87336855 | (05) | CO |