Healthcare Provider Details

I. General information

NPI: 1023314838
Provider Name (Legal Business Name): KIMBERLEY JO WORKMAN DOM, MSOM, DIPL. OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 CARLISLE BLVD NE STE A
ALBUQUERQUE NM
87107-4535
US

IV. Provider business mailing address

2614 DEL NORTE DR SW
ALBUQUERQUE NM
87105-5627
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-7830
  • Fax:
Mailing address:
  • Phone: 505-301-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1058
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: