Provider Demographics
NPI:1386614584
Name:MINER, KIMBERLY J (ND, CNS, CWCN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:MINER
Suffix:
Gender:F
Credentials:ND, CNS, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7399 S SYRACUSE CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1749
Mailing Address - Country:US
Mailing Address - Phone:303-789-2777
Mailing Address - Fax:303-789-2556
Practice Address - Street 1:888 W ITHACA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3468
Practice Address - Country:US
Practice Address - Phone:303-789-2777
Practice Address - Fax:303-789-2556
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1040364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63422549Medicaid
CO478558Medicare ID - Type Unspecified
COP72297Medicare UPIN