Traci a. Kimball MD PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

TRACI A. KIMBALL MD PC

Doing business as

The Wish Clinic

Practice address

10050 Ralston Rd Unit 3
Arvada, CO 80004-4974

Phone

(303) 940-1611

Fax

(303) 432-2296

NPI assigned

Oct 18, 2023

Organization subpart

No

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

Authorized official

Name

Traci A. KimballNPI 1841337110

Title

Owner

Phone

(303) 940-1611

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 1

• The Wish Clinic Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Traci a. Kimball MD PC

  dba The WISH Clinic

  • Multi-Specialty Clinic/Center
  • Arvada, CO
  • NPI 1326449646

  O20150701000301

  Same enrollment

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Traci A. Kimball, MD CWSP

  • Surgery Physician
  • Arvada, CO
  • NPI 1841337110

  Health & Wellness Coach

  NPD Authorized official
• Bonnie Ferrell, FNP

  • Family Nurse Practitioner
  • Denver, CO
  • NPI 1184173213
  NPD
• Matthew Emmett Harris, PA-C

  • Physician Assistant
  • Loveland, CO
  • NPI 1255648598
  NPD
• Jacqueline Moraa Mogusu

  • General Practice Physician
  • Carrollton, TX
  • NPI 1881162527
  NPD
• Amber Lynn Carpenter, P.T.

  • Specialist
  • Wheat Ridge, CO
  • NPI 1093763849
  NPD (past)
• Kerri Holman, BSN, RN, CWON

  • Registered Nurse
  • Denver, CO
  • NPI 1538755061

  Wound Care

  NPD (past)

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773619200000",
    "number": "1174305601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 3",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044974",
            "telephone_number": "303-940-1611",
            "fax_number": "303-432-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 3",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044974",
            "telephone_number": "303-940-1611",
            "fax_number": "303-432-2296"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4798 S Acoma St",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801106541",
            "country_code": "US",
            "telephone_number": "303-940-1611",
            "fax_number": "303-432-2296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRACI A. KIMBALL MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-940-1611"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1744R1102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist, Research Study",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Exercise Physiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000223352",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.thewishclinic.com",
            "affiliation": "N",
            "endpointDescription": "domain",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4798 S Acoma St",
            "city": "Englewood",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801106541",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.thewishclinic.com",
            "affiliation": "N",
            "endpointDescription": "domain",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10050 Ralston Rd Unit 3",
            "city": "Arvada",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800044974",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Wish Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wish Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David R Torres, MD
• Total Renal Care of Colorado Inc (Arvada Dialysis Center)
• David L Toth, RNFA
• Towne Square Associates, LLC
• Elizabeth Gean Tracey
• Traci a. Kimball MD PC (The WISH Clinic)
• Hannah Jean Dangerfield Tracy, AGPCNP
• Hannie Ngoc Tran
• Transition Counseling, PC
• Kristen Traw, RN

• Durable Medical Equipment & Medical Supplies in Arvada, CO
• Providers in Arvada, CO by specialty
• Durable Medical Equipment & Medical Supplies in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.