Healthcare Provider Details

I. General information

NPI: 1821981655
Provider Name (Legal Business Name): HART PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 JEFFERSON ST NE STE A-1
ALBUQUERQUE NM
87109-4382
US

IV. Provider business mailing address

7513 LAMPLIGHTER LN NE
ALBUQUERQUE NM
87109-3218
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-8167
  • Fax:
Mailing address:
  • Phone: 505-385-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A HART
Title or Position: OWNER/OPERATOR
Credential: CPNP
Phone: 505-385-8167