Provider Demographics
NPI:1710370556
Name:PELKEY, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PELKEY
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:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-1612
Mailing Address - Country:US
Mailing Address - Phone:505-384-0220
Mailing Address - Fax:505-384-0222
Practice Address - Street 1:717 W ABRAHAMES RD
Practice Address - Street 2:SUITE D
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-8197
Practice Address - Country:US
Practice Address - Phone:505-384-0220
Practice Address - Fax:505-384-0222
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker