Provider Demographics
NPI:1477560423
Name:LESLIE, KIMBERLY KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:LESLIE
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 1:5201 RIO GRANDE BLVD., NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:319-621-2145
Mailing Address - Fax:319-356-3901
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER
Practice Address - Street 2:2500 MARBLE AVE NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:83106
Practice Address - Country:US
Practice Address - Phone:505-272-5849
Practice Address - Fax:319-356-3901
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38522207V00000X
IAMD-38522207VM0101X
NM2002-0172207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923228Medicare PIN