Provider Demographics
NPI:1023314838
Name:WORKMAN, KIMBERLEY JO (DOM, MSOM, DIPL OM)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:JO
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:DOM, MSOM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 DEL NORTE DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-5627
Mailing Address - Country:US
Mailing Address - Phone:505-301-7830
Mailing Address - Fax:
Practice Address - Street 1:3916 CARLISLE BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4535
Practice Address - Country:US
Practice Address - Phone:505-301-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist