Provider Demographics
NPI:1699500785
Name:LOPEZ, HEATHER KIMBRELL (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KIMBRELL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W D. L. INGRAM AVENUE, BLDG. 1408
Mailing Address - Street 2:
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-784-2778
Mailing Address - Fax:575-784-2308
Practice Address - Street 1:224 W D. L. INGRAM AVENUE, BLDG. 1408
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-2778
Practice Address - Fax:575-784-2308
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9486920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse