Basic Information
| Provider Information | |||||||||
| NPI: | 1053838367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUPPENHEIMER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | COLLEEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 BRANTFEATHER GRV | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809066907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193448564 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 COCHRANE CIRCLE | ||||||||
| Address2: | FORT CARSON, EVANS ARMY HOSPITAL, WARRIOR CLINIC | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195269277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0005100 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.