Provider Demographics
NPI:1699967331
Name:YORK, KIMBERLY R (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:YORK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:R
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049-0130
Mailing Address - Country:US
Mailing Address - Phone:505-552-5438
Mailing Address - Fax:505-552-5811
Practice Address - Street 1:1-40 EXIT 102
Practice Address - Street 2:
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049-0130
Practice Address - Country:US
Practice Address - Phone:505-552-5438
Practice Address - Fax:505-552-5811
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY492058163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY492058OtherNURSING