Healthcare Provider Details

I. General information

NPI: 1326657453
Provider Name (Legal Business Name): KALI KUNDOMAL DNP, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BRANDON WAY
ROSWELL NM
88201-9799
US

IV. Provider business mailing address

2500 BRANDON WAY
ROSWELL NM
88201-9799
US

V. Phone/Fax

Practice location:
  • Phone: 575-420-9542
  • Fax:
Mailing address:
  • Phone: 575-420-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: