Provider Demographics
NPI:1114726106
Name:KINZIE, KARIE ANN (AGACNP)
Entity type:Individual
Prefix:MS
First Name:KARIE
Middle Name:ANN
Last Name:KINZIE
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5246
Mailing Address - Country:US
Mailing Address - Phone:951-425-0395
Mailing Address - Fax:
Practice Address - Street 1:2000 THOMAS DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5246
Practice Address - Country:US
Practice Address - Phone:951-425-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034273363LA2100X
NM67514363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care