Provider Demographics
NPI:1497532691
Name:BACOLOR, KIMBERLY (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BACOLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:BACOLOR
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8291 PALLADIUM ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4133
Mailing Address - Country:US
Mailing Address - Phone:702-521-7190
Mailing Address - Fax:
Practice Address - Street 1:8291 PALLADIUM ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4133
Practice Address - Country:US
Practice Address - Phone:702-521-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV870538363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner