Provider Demographics
NPI:1720287576
Name:JANETZKY, KIM (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:JANETZKY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 STANFORD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3721
Mailing Address - Country:US
Mailing Address - Phone:505-841-4100
Mailing Address - Fax:505-841-4147
Practice Address - Street 1:1111 STANFORD DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3721
Practice Address - Country:US
Practice Address - Phone:505-841-4100
Practice Address - Fax:505-841-4147
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR29238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRO1491Medicare UPIN