Provider Demographics
NPI:1720155500
Name:COX, KIMBERLY (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2400 UNSER SE, SUITE 18200
Practice Address - Street 2:PMG OBGYN
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4740
Practice Address - Country:US
Practice Address - Phone:505-462-7333
Practice Address - Fax:505-462-7495
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36569207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96256Medicaid
NM100083Medicare PIN