Provider Demographics
NPI:1881401750
Name:HANSEN, KELLY JULIA (CNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JULIA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7539 NORTHRIDGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3056
Mailing Address - Country:US
Mailing Address - Phone:505-977-7873
Mailing Address - Fax:
Practice Address - Street 1:7539 NORTHRIDGE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3056
Practice Address - Country:US
Practice Address - Phone:505-977-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-14
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily