Healthcare Provider Details

I. General information

NPI: 1972619567
Provider Name (Legal Business Name): KATHLEEN ANN KRAFT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE
ALBUQUERQUE NM
87111-3575
US

IV. Provider business mailing address

PO BOX 537
SANDIA PARK NM
87047-0537
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8575
  • Fax: 52-928-4095
Mailing address:
  • Phone: 575-815-9224
  • Fax: 505-286-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR22638
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: