Healthcare Provider Details

I. General information

NPI: 1780860049
Provider Name (Legal Business Name): KIMBERLY HERBERT M.S., ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 WELLS ST
LAS CRUCES NM
88003-1304
US

IV. Provider business mailing address

1815 WELLS ST
LAS CRUCES NM
88003-1304
US

V. Phone/Fax

Practice location:
  • Phone: 575-646-6011
  • Fax: 575-646-3435
Mailing address:
  • Phone: 575-646-6011
  • Fax: 575-646-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number392
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: