Healthcare Provider Details

I. General information

NPI: 1104356963
Provider Name (Legal Business Name): KIM HESTAND CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/21/2022
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W COUNTRY CLUB RD STE 230
ROSWELL NM
88201-5240
US

IV. Provider business mailing address

300 W COUNTRY CLUB RD STE 230
ROSWELL NM
88201-5240
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-1411
  • Fax: 575-624-5630
Mailing address:
  • Phone: 575-622-1411
  • Fax: 575-624-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP03246
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: