Healthcare Provider Details

I. General information

NPI: 1114726106
Provider Name (Legal Business Name): KARIE ANN KINZIE AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

2930 HILLRISE DR STE 2
LAS CRUCES NM
88011-4776
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-6687
  • Fax:
Mailing address:
  • Phone: 575-904-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number67514
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95034273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: