Provider Demographics
NPI:1407333446
Name:ROBERTSON, KIMBERLY ANN (AGACNP-BC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5770 FLINTRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1870
Mailing Address - Country:US
Mailing Address - Phone:719-445-9902
Mailing Address - Fax:719-387-0312
Practice Address - Street 1:5770 FLINTRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1870
Practice Address - Country:US
Practice Address - Phone:719-445-9902
Practice Address - Fax:719-387-0312
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012049A363LG0600X
CO0993998363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology