Provider Demographics
NPI:1366276859
Name:MARES, KIMBERLY V (RN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:V
Last Name:MARES
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 1:10 RANGER RD
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-2340
Mailing Address - Country:US
Mailing Address - Phone:575-387-3217
Mailing Address - Fax:
Practice Address - Street 1:3549 STATE HIGHWAY 518
Practice Address - Street 2:
Practice Address - City:HOLMAN
Practice Address - State:NM
Practice Address - Zip Code:87723-2006
Practice Address - Country:US
Practice Address - Phone:575-387-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-84829163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool