Provider Demographics
NPI:1710369319
Name:KNEIB, JESSICA LEE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:KNEIB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:STE 4620
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4922
Practice Address - Country:US
Practice Address - Phone:505-841-1995
Practice Address - Fax:505-841-1373
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2024-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMA-2368-20207ZP0102X
MO2015019326207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology