Healthcare Provider Details

I. General information

NPI: 1427264316
Provider Name (Legal Business Name): EUGENE E KIMZEY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ZUNI RD SE
ALBUQUERQUE NM
87108-3073
US

IV. Provider business mailing address

933 LA LUZ DR NW
ALBUQUERQUE NM
87107-3544
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-8978
  • Fax:
Mailing address:
  • Phone: 505-344-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR21303
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: