Provider Demographics
NPI:1992295299
Name:DUTTON, KIMBERLEE ANN (CNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:ANN
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNC
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:TOME
Mailing Address - State:NM
Mailing Address - Zip Code:87060-0273
Mailing Address - Country:US
Mailing Address - Phone:505-306-5136
Mailing Address - Fax:
Practice Address - Street 1:3715 LAS ESTANCIAS CT SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121
Practice Address - Country:US
Practice Address - Phone:505-727-4200
Practice Address - Fax:505-727-4949
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR63368163WX0003X
NM53116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53116OtherCNP LICENSE