1013986710 NPI number — MRS. KIMBERLY A SPANGRUDE FNP-C

Table of content: MRS. KIMBERLY A SPANGRUDE FNP-C (NPI 1013986710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013986710 NPI number — MRS. KIMBERLY A SPANGRUDE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPANGRUDE
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013986710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 E. MAIN ST.
Provider Second Line Business Mailing Address:
BUSINESS OPTIONS MEDICAL BILLING
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-765-0810
Provider Business Mailing Address Fax Number:
970-497-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3354 E RUTLAND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTTONWOOD HEIGHTS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84121-5829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-971-1739
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  C-APN.0991964-C-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 223145-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 451870YS6E . This is a "MEDICARE PART B FOR LBN: OLATHE COMMUNITY CLINIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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