Provider Demographics
NPI:1487283040
Name:SHANKS, KRISTEN JOY (CNM)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:JOY
Last Name:SHANKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:JOY
Other - Last Name:GALBREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 844088
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4088
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:634 W PINON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5915
Practice Address - Country:US
Practice Address - Phone:505-609-2000
Practice Address - Fax:505-609-2259
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM788176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife