Provider Demographics
NPI:1225823255
Name:OLGUIN, KAMI (NP)
Entity type:Individual
Prefix:
First Name:KAMI
Middle Name:
Last Name:OLGUIN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROAD 3215
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2440
Mailing Address - Country:US
Mailing Address - Phone:505-486-6979
Mailing Address - Fax:
Practice Address - Street 1:4337 E MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8634
Practice Address - Country:US
Practice Address - Phone:505-326-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily