Individual provider Active NPI

Kimberly Wenninghoff, DNP, FNP

  • Family Nurse Practitioner
  • Northglenn, CO
National Provider Identifier
1841776101
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2018008059 Issued in TN
Practice address
10761 Claire LN
Northglenn, CO 80234-3730
Phone
(520) 228-1511
NPI assigned
Jul 19, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2018008059 TN Primary

Addresses

Primary practice location

10761 Claire LN
Northglenn, CO 80234-3730

Mailing address

10761 Claire LN
Northglenn, CO 80234-3730

Other practice location 1

2270 Garden Of The Gods Rd Ste 103
Colorado Spgs, CO 80907-9440
Phone (720) 456-3989

Other practice location 2

680 W 121st Ave Ste 110
Westminster, CO 80234-4223
Phone (720) 595-2089

Other practice location 3

7307 S Revere Pkwy Ste 201
Centennial, CO 80112-3931
Phone (720) 456-3989

Other identifiers 1

IdentifierTypeStateIssuer
APN.0997010-NPOtherCOCOLORADO NP LICENSING

Other names 1

  • Kimberly Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221222000855 CO Practitioner - Nurse Practitioner 0648519090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6912 S Quentin St
Suite 50
Centennial, CO 80112-4531

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2018008059TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaic Infusion Solutions LLC Current Accepting new patients
Mosaic Infusion Solutions LLC CurrentSince Nov 1, 2022 Accepting new patients
Mosaic Infusion Solutions LLC CurrentSince Nov 1, 2022 Accepting new patients

Locations

7307 S Revere Pkwy
Ste 201
Centennial, CO 80112
Phone (720) 456-3989

2270 Garden of the Gods Rd
Ste 103
Colorado Springs, CO 80907
Phone (719) 785-1378

6912 S Quentin St
Ste 50
Englewood, CO 80112

680 W 121st Ave
Ste 110
Westminster, CO 80234
Phone (208) 640-6096

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1841776101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10761 CLAIRE LN",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802343730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10761 CLAIRE LN",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802343730",
            "telephone_number": "520-228-1511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2270 Garden Of The Gods Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Colorado Spgs",
            "state": "CO",
            "postal_code": "809079440",
            "country_code": "US",
            "telephone_number": "720-456-3989",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 W 121st Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "CO",
            "postal_code": "802344223",
            "country_code": "US",
            "telephone_number": "720-595-2089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7307 S Revere Pkwy Ste 201",
            "address_purpose": "LOCATION",
            "city": "Centennial",
            "state": "CO",
            "postal_code": "801123931",
            "country_code": "US",
            "telephone_number": "720-456-3989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENNINGHOFF",
        "first_name": "KIMBERLY",
        "credential": "DNP, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-19",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "2018008059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO NP LICENSING",
            "identifier": "APN.0997010-NP",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "JOHNSON",
            "credential": "DNP,FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Northglenn, CO

Sources for this page

Verify at the official NPI Registry.