Provider Demographics
NPI:1710066287
Name:BENNETT, KIMBERLY STATLER (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STATLER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:STATLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8289 E LOWRY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7256
Mailing Address - Country:US
Mailing Address - Phone:303-321-2828
Mailing Address - Fax:303-321-7171
Practice Address - Street 1:8289 E LOWRY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7256
Practice Address - Country:US
Practice Address - Phone:303-321-2828
Practice Address - Fax:303-321-7171
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0053849207QH0002X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine