Provider Demographics
NPI:1205836780
Name:MOHR, KIM ELAINE (CNS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELAINE
Last Name:MOHR
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 FORESIGHT CIRCLE
Mailing Address - Street 2:#2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-254-8600
Mailing Address - Fax:970-254-8603
Practice Address - Street 1:2516 FORESIGHT CIRCLE
Practice Address - Street 2:#2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-254-8600
Practice Address - Fax:970-254-8603
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99868163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71576053Medicaid
COC805305Medicare PIN
CO71576053Medicaid