Provider Demographics
NPI:1790252328
Name:MERELMAN, KIMBERLY MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:MERELMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3668
Mailing Address - Country:US
Mailing Address - Phone:505-727-7090
Mailing Address - Fax:
Practice Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3668
Practice Address - Country:US
Practice Address - Phone:505-727-7090
Practice Address - Fax:505-727-9590
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005715363A00000X
NMPA2022-0060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70355550Medicaid
NMPA.2022-0060OtherNM PHYSICIAN ASSISTANT LICENCE
CO9000170559Medicaid