Provider Demographics
NPI:1467627919
Name:KEMPISTY, KIMBERLY A (RDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:KEMPISTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1946
Mailing Address - Street 2:1090 GOAT SPRINGS ROAD
Mailing Address - City:TAOS,
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1946
Mailing Address - Country:US
Mailing Address - Phone:575-758-4224
Mailing Address - Fax:575-751-5210
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:TAOS,
Practice Address - State:NM
Practice Address - Zip Code:87571-1946
Practice Address - Country:US
Practice Address - Phone:575-758-4224
Practice Address - Fax:575-751-5210
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902010086124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK3543Medicaid
NMK3543Medicaid