Provider Demographics
NPI:1245527837
Name:CRIBBS, KAYLENE (FNP)
Entity type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:CRIBBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 MESSINA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4782
Mailing Address - Country:US
Mailing Address - Phone:505-591-0636
Mailing Address - Fax:505-393-6623
Practice Address - Street 1:3510 MESSINA DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4782
Practice Address - Country:US
Practice Address - Phone:505-591-0636
Practice Address - Fax:505-393-6626
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02732363LF0000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500637771Medicaid
OR201150053NPOtherFNP LICENSE