Active NPI
Kimberly Sue Ottolenghi, CPNP
- Nurse Practitioner
- Ft. Collins, CO
National Provider Identifier
1720086200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 107622
- Practice address
- 2001 S Shields
BLDG G
Ft. Collins, CO 80526 - Phone
- (970) 484-4871
- Fax
- (970) 482-4927
- NPI assigned
- Jul 8, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2899 | CO | |
| Nurse Practitioner | 363L00000X | 107622 | CO | Primary |
Addresses
Primary practice location
2001 S Shields
BLDG G
Ft. Collins, CO 80526
Mailing address
2001 S Shields
BLDG G
Fort Collins, CO 80526
Phone (970) 484-4871
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77129849 | Medicaid | CO |
Other names 1
- Kimberly Sue Burns
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2899 | CO | MD | Rehabilitation Psychologist |
| 107622 | CO | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates of Northern Colorado | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Fort Collins, CO
- NPI 1336419530
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276214400000",
"number": "1720086200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 S SHIELDS",
"address_2": "BLDG G",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "80526",
"telephone_number": "970-484-4871",
"fax_number": "970-482-4927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 S SHIELDS",
"address_2": "BLDG G",
"city": "FT. COLLINS",
"state": "CO",
"postal_code": "80526",
"telephone_number": "970-484-4871",
"fax_number": "970-482-4927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTOLENGHI",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-08",
"last_updated": "2010-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CO",
"license": "2899",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CO",
"license": "107622",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77129849",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "BURNS",
"middle_name": "SUE",
"credential": "PNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ft. Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.