Healthcare Provider Details

I. General information

NPI: 1629485511
Provider Name (Legal Business Name): KIRSTEN KAY ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ENTERPRISE RD
SOCORRO NM
87801
US

IV. Provider business mailing address

PO BOX 248 1300 ENTERPRISE RD
SOCORRO NM
87801
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4444
  • Fax: 575-835-1010
Mailing address:
  • Phone: 575-835-4444
  • Fax: 575-835-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: