Individual
KIMBERLY JOY WAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1901 JUAN TABO BLVD NE STE B, ALBUQUERQUE, NM 87112-3303
(505) 281-5180
(505) 702-8171
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(877) 498-4490
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-00955
NC
363A00000X
Physician Assistant
Primary
PA2026-0045
NM
Other
Enumeration date
06/22/2007
Last updated
05/26/2026
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