# KIM P LARK DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720275357
- **Authorized official:** MS. CHRISTI MICHELLE YERBY (BILLING SPECIALIST)
- **Authorized official phone:** (505) 234-9964

## Contact information

- **Practice address:** 2402 W PIERCE ST, STE 4A, CARLSBAD, NM 88220-3537
- **Practice address phone:** (505) 234-9964
- **Practice address fax:** (505) 234-9962
- **Mailing address:** 2402 W PIERCE ST, STE 4A, CARLSBAD, NM 88220-3537
- **Mailing address phone:** (505) 234-9964
- **Mailing address fax:** (505) 234-9962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | A110698 | NM | Yes |

## Other

- **Enumeration date:** 09/27/2007
- **Last updated:** 11/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00T9592 | — | NM |
| 01 | — | NM004378 | BCBS | NM |