Provider Demographics
NPI:1003147984
Name:ANDERSON, KIM PATRICIA (KIM ANDERSON RN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:PATRICIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:KIM ANDERSON RN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:PATRICIA
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KIM THOMSON RN
Mailing Address - Street 1:1011 ARAPAHOE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1065
Mailing Address - Country:US
Mailing Address - Phone:303-720-0610
Mailing Address - Fax:
Practice Address - Street 1:11245 HURON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2806
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65871163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics