Individual
MRS. KIMBERLY MARIE MERELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
715 DR MARTIN LUTHER KING JR AVE NE STE 301, ALBUQUERQUE, NM 87102-3668
(505) 727-7090
(505) 727-9590
Mailing address
715 DR MARTIN LUTHER KING JR AVE NE STE 301, ALBUQUERQUE, NM 87102-3668
(505) 727-7090
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0005715
CO
363A00000X
Physician Assistant
Primary
PA2022-0060
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70355550
—
NM
05
—
9000170559
—
CO
01
—
PA.2022-0060
NM PHYSICIAN ASSISTANT LICENCE
NM
Enumeration date
11/01/2018
Last updated
01/05/2024
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