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General NPI Number Information
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NPI Number | 1669270310
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Entity Type | Individual
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Provider Name | KIMBERLY FUSSELMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 490A W ZIA RD
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City | SANTA FE
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State | NM
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Zip | 87505-6996
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Country | US
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Telephone | 505-913-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 DIETZ FARM RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3117
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Country | US
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Telephone | 505-715-0008
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2025-0024
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License Number State | NM
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