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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANN JOY FNP

MEDICARE: MRS. KIMBERLY ANN JOY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner110498NE
2363LF0000XFamily Nurse PractitionerCNP-02255NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679549257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANN JOY FNP
Provider Business Mailing Address
First Line : PO BOX 158
Second Line : 538 N. PASEO DE ONATE
City : ESPANOLA
State : NM
Zip : 87532-0158
Country : US
Telephone Number : 505-753-7218
Fax Number : 505-747-7396
Provider Business Practice Location Address
First Line : 2010 INDUSTRIAL PARK RD
Second Line : EL CENTRO FAMILYHEALTH - RIO ARRIBA HEALTH COMMONS
City : ESPANOLA
State : NM
Zip : 87532-3600
Country : US
Telephone Number : 505-753-7395
Fax Number : 505-753-8373
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 10/14/2013

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Directions to “ MRS. KIMBERLY ANN JOY FNP” Practice Location

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