MEDICARE: KATHLEEN ANN KRAFT FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R22638	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972619567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANN KRAFT FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 537
Second Line	:
City	:	SANDIA PARK
State	:	NM
Zip	:	87047-0537
Country	:	US
Telephone Number	:	575-815-9224
Fax Number	:	505-286-7858

Provider Business Practice Location Address
First Line	:	3825 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3575
Country	:	US
Telephone Number	:	505-292-8575
Fax Number	:	52-928-4095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	06/02/2022

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