Healthcare Provider Details

I. General information

NPI: 1033587290
Provider Name (Legal Business Name): KIM BEAR F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 CAMINO CRUZ BLANCA
SANTA FE NM
87505-4584
US

IV. Provider business mailing address

133 ARROYO HONDO TRL
SANTA FE NM
87508-9356
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-6000
  • Fax:
Mailing address:
  • Phone: 505-660-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCS00222138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: