Provider Demographics
NPI:1588268650
Name:RANDALL, KIMBERLY (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RANDALL
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:HOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1441 RED MICA WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7437
Mailing Address - Country:US
Mailing Address - Phone:719-639-8396
Mailing Address - Fax:
Practice Address - Street 1:7707 FOREST VALLEY LOOP
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-5649
Practice Address - Country:US
Practice Address - Phone:719-639-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0186699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse