Provider Demographics
NPI:1639445257
Name:PADEN-HARRIS, KIMBERLEY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JEAN
Last Name:PADEN-HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-1920
Mailing Address - Country:US
Mailing Address - Phone:970-824-1020
Mailing Address - Fax:970-824-5300
Practice Address - Street 1:595 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1920
Practice Address - Country:US
Practice Address - Phone:970-824-1020
Practice Address - Fax:970-824-5300
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752990363LF0000X
COAPN.0994800-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily