Provider Demographics
NPI:1710921846
Name:MARTINEZ, KELLEY P (CFNP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:P
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7788 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4342
Mailing Address - Country:US
Mailing Address - Phone:505-999-1600
Mailing Address - Fax:505-999-1650
Practice Address - Street 1:7788 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4342
Practice Address - Country:US
Practice Address - Phone:505-999-1600
Practice Address - Fax:505-999-1650
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-00884363LF0000X
NMR39917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA032OtherTRICARE
NMNM301783Medicare UPIN