Individual
OLIVIA KIMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-2724
(505) 367-0340
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
53443
NM
363LF0000X
Family Nurse Practitioner
Primary
APRN-4547
HI
363LF0000X
Family Nurse Practitioner
F06180294
NM
Other
Enumeration date
06/28/2018
Last updated
09/04/2024
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