Provider Demographics
NPI:1225145766
Name:KMIECIK, MARGO M (APNP)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:M
Last Name:KMIECIK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 VUELTA VISTOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4605
Mailing Address - Country:US
Mailing Address - Phone:505-670-9244
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5806
Practice Address - Country:US
Practice Address - Phone:214-689-8178
Practice Address - Fax:866-522-6596
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI356-033363L00000X
WI57883-030363L00000X
NMCNP-02515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner