Provider Demographics
NPI:1992701759
Name:GONZALES, DORIS KAY (CNP)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:KAY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:KAY
Other - Last Name:GARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4005 HIGH RESORT BLVD SE
Mailing Address - Street 2:PMG RIO RANCHO HIGH RESORT 4005
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5906
Mailing Address - Country:US
Mailing Address - Phone:505-462-6000
Mailing Address - Fax:
Practice Address - Street 1:4005 HIGH RESORT BLVD SE
Practice Address - Street 2:PMG RIO RANCHO HIGH RESORT 4005
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5906
Practice Address - Country:US
Practice Address - Phone:505-462-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100411810CMedicaid
NM06972365Medicaid
KS100411810CMedicaid
NMNM302197Medicare PIN