Provider Demographics
NPI:1366098790
Name:CAMPBELL, KIMISHA
Entity type:Individual
Prefix:MS
First Name:KIMISHA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 N DOWNING ST UNIT 23-203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4412
Mailing Address - Country:US
Mailing Address - Phone:720-291-8957
Mailing Address - Fax:303-291-8956
Practice Address - Street 1:2844 N DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4412
Practice Address - Country:US
Practice Address - Phone:720-291-8957
Practice Address - Fax:303-291-8956
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0188878163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse