Kim H Irving, ANP
Individual provider Active NPI Ambulatory Care Registered Nurse · Black Hawk, CO
NPI 1508970823 · NPPES record last updated Jul 31, 2013
Key facts
- NPI
- 1508970823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ambulatory Care Registered Nurse 163WP2201X
- License
- RXN 97-125 (CO)
- Practice address
- 562 Gregory Street
Black Hawk, CO 80422 - Phone
- (303) 582-5276
- Fax
- (303) 582-1003
- NPI assigned
- Aug 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151228000458 | CO | Order and Referring Only - Nurse Practitioner | 5698076263 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52786 | CO | MD | Registered Nurse |
| RXN 97-125 | CO | MD | Ambulatory Care Registered Nurse |
| 0001288 | CO | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Family Health Centers | Past | Accepting new patients |
Interoperability endpoints
- kim.irving.1@22647.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 52786 | CO | |
| Ambulatory Care Registered Nurse | 163WP2201X | RXN 97-125 | CO | Yes |
| Primary Care Nurse Practitioner | 363LP2300X | 0001288 | CO |
Addresses
Primary practice location
562 Gregory Street
Black Hawk, CO 80422
Mailing address
PO Box 66
Black Hawk, CO 80422-0066
Phone (303) 582-5276
Other providers in Black Hawk, CO
- Gilpin Ambulance Inc.
- Gilpin County
- Amy Hager
- Hi-Tech Hearing
- Carol Joan Holdcroft
- Jefferson Center for Mental Health
- Jefferson Center for Mental Health
- Brook Jordan
- Jonelle Kirkpatrick
- Jason Alexander Kopen
All providers in Black Hawk, CO · Ambulatory Care Registered Nurse in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.