Provider Demographics
NPI:1356897250
Name:WHITAKER, KYM LITTLEFIELD (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:LITTLEFIELD
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:KYM
Other - Middle Name:LITTLEFIELD
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:10263 CAPITAL PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4447
Mailing Address - Country:US
Mailing Address - Phone:076-314-3653
Mailing Address - Fax:
Practice Address - Street 1:110 ENT AVENUE
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CA
Practice Address - Zip Code:80914
Practice Address - Country:US
Practice Address - Phone:719-556-1306
Practice Address - Fax:719-556-1226
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992546-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily