Healthcare Provider Details

I. General information

NPI: 1437586476
Provider Name (Legal Business Name): KIMBERLY ANN MADDEN MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEDICINE HORSE DR
TOHAJIILEE NM
87026-5145
US

IV. Provider business mailing address

11700 BUCKING BRONCO TRL SE
ALBUQUERQUE NM
87123-3503
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-2307
  • Fax: 505-908-2310
Mailing address:
  • Phone: 253-844-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number227528
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-77939
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN-77939
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number105990
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number105990
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number105990
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number227528
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number227528
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: