Individual
KIMBERLY NICOLE STA ANA HENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1609 N PRINCE ST, CLOVIS, NM 88101-4850
(575) 935-0360
(575) 935-0361
Mailing address
6 N OAK ST, PERRYVILLE, MO 63775-2733
(573) 768-5958
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6123
NM
Other
Enumeration date
05/31/2023
Last updated
06/04/2023
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