Provider Demographics
NPI:1548214844
Name:HOPES, KERRY COLLEEN (CPNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:COLLEEN
Last Name:HOPES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E BLAND ST
Mailing Address - Street 2:SBHC
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-7900
Mailing Address - Country:US
Mailing Address - Phone:575-627-2808
Mailing Address - Fax:575-624-2290
Practice Address - Street 1:1601 E BLAND ST
Practice Address - Street 2:SBHC
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-7900
Practice Address - Country:US
Practice Address - Phone:575-627-2808
Practice Address - Fax:575-624-2290
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR37868363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00F5138Medicaid
NM00F5138Medicaid