Provider Demographics
NPI:1245543768
Name:KIMPEL, KATIE ANN (NP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:KIMPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL
Mailing Address - Street 2:SUITE 365
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1575
Mailing Address - Country:US
Mailing Address - Phone:720-321-8280
Mailing Address - Fax:720-321-8281
Practice Address - Street 1:415 SAINT CLAIR RD STE B
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409
Practice Address - Country:US
Practice Address - Phone:318-528-3223
Practice Address - Fax:318-528-3224
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN113323-APO6187163WG0000X
COAPN.0991447-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2145878Medicaid
LA2145878Medicaid