Provider Demographics
NPI:1417214347
Name:GIBBS, KIMBERLY (LMT, RMTI)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LMT, RMTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19A ARROYO NAMBE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-7120
Mailing Address - Country:US
Mailing Address - Phone:505-795-3357
Mailing Address - Fax:
Practice Address - Street 1:1315 S SAINT FRANCIS DR STE 3
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4035
Practice Address - Country:US
Practice Address - Phone:505-795-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist