Healthcare Provider Details

I. General information

NPI: 1720907892
Provider Name (Legal Business Name): KIMBERLY GUADALUPE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 401
LAS CRUCES NM
88011-8261
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 401
LAS CRUCES NM
88011-8261
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4767
  • Fax:
Mailing address:
  • Phone: 575-522-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number90681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: