Healthcare Provider Details

I. General information

NPI: 1063603512
Provider Name (Legal Business Name): JULIE KILPATRICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 DECKER AVE NW
ALBUQUERQUE NM
87107-2969
US

IV. Provider business mailing address

2724 DECKER AVE NW
ALBUQUERQUE NM
87107-2969
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6944
  • Fax:
Mailing address:
  • Phone: 505-345-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number90-223
License Number StateNM

VIII. Authorized Official

Name: DR. JULIE KILPATRICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-345-6944