Provider Demographics
NPI:1366407785
Name:REA, KIMBERLEY A (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:REA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:706-242-4229
Mailing Address - Fax:970-490-4155
Practice Address - Street 1:4660 YOSEMITE ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-4481
Practice Address - Country:US
Practice Address - Phone:720-516-8907
Practice Address - Fax:720-516-8905
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1061543163WG0000X
KY4058P363LA2200X
CONP0006039363LA2200X
VA0024170292364SA2200X
COAPN.0006039-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012572Medicaid
CO321797YPNBOtherMEDICARE PTAN
COCO304703/CO307663OtherMEDICARE
00198508OtherRAILROAD MEDICARE
KY0361967Medicare PIN
KYQ02387Medicare UPIN