Provider Demographics
NPI:1891598934
Name:LARA, KIMBERLY A (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:LARA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:652 CINNABAR LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3089
Mailing Address - Country:US
Mailing Address - Phone:720-768-3320
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:720-768-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0128435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse