Provider Demographics
NPI:1073932471
Name:PRUETT, KIMBERLY MARIE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE RUTH
Last Name:PRUETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNM DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - Street 2:1 UNM, MSC 11 6025
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-5560
Mailing Address - Fax:505-272-6503
Practice Address - Street 1:UNM DEPARTMENT OF EMERGENCY MEDICINE 1 UNM
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-4700
Practice Address - Country:US
Practice Address - Phone:505-272-5560
Practice Address - Fax:505-272-6503
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2017-0629207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program