Provider Demographics
NPI:1811372857
Name:PEREZ, KIMBERLY ANN (CNM, CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CNM, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 PLAZA BLANCA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5343
Mailing Address - Country:US
Mailing Address - Phone:505-795-3000
Mailing Address - Fax:
Practice Address - Street 1:1703 1/2 LENA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2001
Practice Address - Country:US
Practice Address - Phone:505-309-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69168363LW0102X
COAPN 0991807-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMAPNCNP69168OtherNM BOARD OF NURSING
COAPN 0991807OtherCOLORADO LICENSE