Provider Demographics
NPI:1750305884
Name:TOWNSEND, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TOWNSEND
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 1:1624 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5129
Mailing Address - Country:US
Mailing Address - Phone:970-353-5959
Mailing Address - Fax:970-353-5967
Practice Address - Street 1:1624 17TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5129
Practice Address - Country:US
Practice Address - Phone:970-353-5959
Practice Address - Fax:970-353-5967
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96483342Medicaid
449568Medicare ID - Type Unspecified
P45421Medicare UPIN
COC809330Medicare PIN