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General NPI Number Information
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NPI Number | 1487428843
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Entity Type | Individual
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Provider Name | KIMBERLY PINE DOUGHARTY LPAT
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Gender | Female
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 4730 BECKNER RD
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City | SANTA FE
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State | NM
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Zip | 87507-3691
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Country | US
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Telephone | 505-989-4500
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Fax | 505-443-8313
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Provider Business Mailing Address
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Address Line | 1009 VELARDE RD
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City | SANTA FE
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State | NM
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Zip | 87507-5126
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Country | US
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Telephone | 253-720-4871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | CTB20230922
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License Number State | NM
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