Organization
A KIDZ CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DOCKTER (EXECUTIVE DIRECTOR)
(970) 874-2753
Entity
Organization
Contact information
Practice address
360 E 8TH ST, DELTA, CO 81416-2379
(970) 874-2753
(970) 399-7005
Mailing address
360 E 8TH ST, DELTA, CO 81416-2379
(970) 874-2753
(970) 874-2943
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89658710
—
CO
Enumeration date
08/05/2014
Last updated
06/11/2024
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