Provider Demographics
NPI:1043097025
Name:VIGLIOTTA, KIMBERLY G (AGCNS - BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:VIGLIOTTA
Suffix:
Gender:F
Credentials:AGCNS - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S PEORIA ST STE 240
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5475
Mailing Address - Country:US
Mailing Address - Phone:303-752-5455
Mailing Address - Fax:
Practice Address - Street 1:2450 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5475
Practice Address - Country:US
Practice Address - Phone:303-752-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2023033516364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist