Provider Demographics
NPI:1376039008
Name:KINIFICK, KURT RICHARD
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:RICHARD
Last Name:KINIFICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 MENAUL BLVD NE STE M
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3184
Mailing Address - Country:US
Mailing Address - Phone:505-880-8898
Mailing Address - Fax:505-881-4952
Practice Address - Street 1:5504 MENAUL BLVD NE STE M
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3184
Practice Address - Country:US
Practice Address - Phone:505-880-8898
Practice Address - Fax:505-881-4952
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM609237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist