Provider Demographics
NPI:1669733838
Name:FLAKE, KIMBERLY NICHOLE (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:FLAKE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:BLOCK
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, PMHNP
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:9362 TEDDY LN STE 106
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2871
Practice Address - Country:US
Practice Address - Phone:720-749-5599
Practice Address - Fax:602-362-2633
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000864363LF0000X
TN16683363LF0000X
CO0998307363LP0808X
MSR868155363LF0000X
COAPN.0998307-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529089Medicaid
TN16683OtherAPN LICENSE
MSR868155OtherLICENSE
TN103I501365Medicare PIN