Provider Demographics
NPI:1902390735
Name:RICH-GAINEY, KIMBERLY ANNETTE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:RICH-GAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MADEIRA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2963
Mailing Address - Country:US
Mailing Address - Phone:505-262-1538
Mailing Address - Fax:505-243-5342
Practice Address - Street 1:123 MADEIRA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2963
Practice Address - Country:US
Practice Address - Phone:505-262-1538
Practice Address - Fax:505-243-5342
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse