Kimberly Bundy-Fazioli

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00000295 Issued in CO

Practice address

101 Main Street
Frisco, CO 80443-9261

Phone

(970) 302-1796

NPI assigned

Jan 7, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindfulness Matters Institute

  • Counselor
  • Breckenridge, CO
  • NPI 1730639048
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1073153144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3699",
            "city": "BRECKENRIDGE",
            "state": "CO",
            "postal_code": "804243699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN STREET",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804439261",
            "telephone_number": "970-302-1796"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 S. Ridge Street",
            "address_purpose": "LOCATION",
            "city": "Breckenridge",
            "state": "CO",
            "postal_code": "80424",
            "country_code": "US",
            "telephone_number": "970-302-1796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNDY-FAZIOLI",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "00000295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Browner, MD
• Elisabeth M. Brozovich, PAC
• Eleanor Lacy Bruin, LCSW
• Annette Bruns, PHARMD
• William Carl Bruns, M.D.
• Karie Watts Burns, FNP
• Sarah Butterworth, RBT
• Hannah Buzzo
• Nathan Ladd Cafferky, MD
• Christopher Cail, PA-C, ATC

• Clinical Social Worker in Frisco, CO
• Providers in Frisco, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.