Provider Demographics
NPI:1013726645
Name:EDWARDS, KIM K
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:K
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2140 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2916
Mailing Address - Country:US
Mailing Address - Phone:970-579-0003
Mailing Address - Fax:970-433-7671
Practice Address - Street 1:2140 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2916
Practice Address - Country:US
Practice Address - Phone:970-579-0003
Practice Address - Fax:970-433-7671
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program