Provider Demographics
NPI:1811057201
Name:BUCKMAN, KIMBERLY ANN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BUCKMAN
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 1:109 LOS MIRADORES DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4279
Mailing Address - Country:US
Mailing Address - Phone:505-275-0812
Mailing Address - Fax:505-332-7512
Practice Address - Street 1:109 LOS MIRADORES DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4279
Practice Address - Country:US
Practice Address - Phone:505-275-0812
Practice Address - Fax:505-332-7512
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A1518Medicaid