Provider Demographics
NPI:1972619567
Name:KRAFT, KATHLEEN ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:KRAFT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-0537
Mailing Address - Country:US
Mailing Address - Phone:575-815-9224
Mailing Address - Fax:505-286-7858
Practice Address - Street 1:3825 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3575
Practice Address - Country:US
Practice Address - Phone:505-292-8575
Practice Address - Fax:052-928-4095
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82204080Medicaid
NMQ38295Medicare UPIN
NM82204080Medicaid