TRACI A. KIMBALL MD PC NPI 1174305601

NPI Information

NPI: 1174305601
Provider Name: TRACI A. KIMBALL MD PC

Doing Business As: THE WISH CLINIC

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
4045 WADSWORTH BLVD STE 10
WHEAT RIDGE, CO
ZIP 80033
Phone: (303) 940-1611
Get Directions

TRACI A. KIMBALL MD PC is a multi-specialty clinic center in Wheat Ridge, CO. TRACI A. KIMBALL MD PC NPI is 1174305601. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As The Wish Clinic.

The provider's business location address is:

4045 WADSWORTH BLVD STE 10
WHEAT RIDGE, CO
ZIP 80033-625
Phone: (303) 940-1611
Fax: (303) 432-2296

The provider's authorized official is Traci A. Kimball .
The authorized official title is Owner, Physician and has the following contact phone number (720) 557-6510.

The enumeration date for this NPI number is 10/18/2023 and was last updated on 2/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	1744R1102X	Specialist	Research Study	No
2	202D00000X	Integrative Medicine		No
3	207QG0300X	Family Medicine	Geriatric Medicine	No
4	208100000X	Physical Medicine & Rehabilitation		No
5	1835P0018X	Pharmacist	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	No
6	208600000X	Surgery		No
7	224Y00000X	Clinical Exercise Physiologist		No
8	103K00000X	Behavior Analyst		No
9	133NN1002X	Nutritionist	Nutrition, Education	No
10	163WC0400X	Registered Nurse	Case Management	No
11	163WI0500X	Registered Nurse	Infusion Therapy	No
12	163WW0000X	Registered Nurse	Wound Care	No
13	164W00000X	Licensed Practical Nurse		No
14	171400000X	Health and Wellness Coach		No
15	261QM1300X	Clinic/Center	Multi-Specialty	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9000223352	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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