Individual
MS. KIMBERLY RACINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3850 N GRANT AVE STE 200, LOVELAND, CO 80538-8431
(970) 624-5170
(970) 669-7521
Mailing address
3850 N GRANT AVE STE 200, LOVELAND, CO 80538
(970) 624-5170
(970) 669-7521
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1481
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61624349
—
CO
01
—
P00944762
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
02/01/2006
Last updated
10/08/2021
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