Basic Information
| Provider Information | |||||||||
| NPI: | 1124107933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDOCK | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7950 KIPLING ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034246466 | ||||||||
| FaxNumber: | 3034208944 | ||||||||
| Practice Location | |||||||||
| Address1: | 7950 KIPLING ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034246466 | ||||||||
| FaxNumber: | 3034208944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | CO 79120 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.