Provider Demographics
NPI:1497171557
Name:BYRD, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 MAIN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4033
Mailing Address - Country:US
Mailing Address - Phone:970-759-5218
Mailing Address - Fax:970-422-8019
Practice Address - Street 1:3710 MAIN AVE STE 301
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4033
Practice Address - Country:US
Practice Address - Phone:970-759-5218
Practice Address - Fax:970-422-8019
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2014-0005363A00000X
COPA0004773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant