Individual
KIMBERLY GILLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2764
CO
363AM0700X
Medical Physician Assistant
PA.0002764
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61688274
—
CO
Enumeration date
03/01/2008
Last updated
07/24/2020
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