1679549257 NPI number — MRS. KIMBERLY ANN JOY FNP

Table of content: MRS. KIMBERLY ANN JOY FNP (NPI 1679549257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679549257 NPI number — MRS. KIMBERLY ANN JOY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOY
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSADO
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679549257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
538 N. PASEO DE ONATE
Provider Business Mailing Address City Name:
ESPANOLA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87532-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-753-7218
Provider Business Mailing Address Fax Number:
505-747-7396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 INDUSTRIAL PARK RD
Provider Second Line Business Practice Location Address:
EL CENTRO FAMILYHEALTH - RIO ARRIBA HEALTH COMMONS
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-753-7395
Provider Business Practice Location Address Fax Number:
505-753-8373
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  110498 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: CNP-02255 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025024400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025024300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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