Provider Demographics
NPI:1386622561
Name:COLLINS, KIMBERLY MARIE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:KESLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1901 REDROCK DR
Mailing Address - Street 2:PFS DEPT
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5683
Mailing Address - Country:US
Mailing Address - Phone:505-863-7000
Mailing Address - Fax:
Practice Address - Street 1:1900 REDROCK DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5682
Practice Address - Country:US
Practice Address - Phone:505-863-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0466208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009H62OtherBC/BS
AZ809824OtherAHCCCS
P00060931OtherRAILROAD MEDICARE
NMPROVP12196OtherMOLINA
NM201042791OtherPRESBYTERIAN HEALTH/SALUD
850313268020OtherCHAMPUS
NM10005144OtherLOVELACE HEALTH/SALUD
NM54580251Medicaid
341328602Medicare ID - Type Unspecified
NMPROVP12196OtherMOLINA