Basic Information
| Provider Information | |||||||||
| NPI: | 1053633529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINGFISHER FOUNDATION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O .BOX 177 | ||||||||
| Address2: | |||||||||
| City: | MEAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034952166 | ||||||||
| FaxNumber: | 3033282304 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 MAIN STREET | ||||||||
| Address2: | UNIT B | ||||||||
| City: | MEAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034952166 | ||||||||
| FaxNumber: | 3033282304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2010 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | GRABER | ||||||||
| AuthorizedOfficialFirstName: | ROD | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3034952166 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP-10086 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.