Active NPI
Susan A Krzymowski, PA
- Physician Assistant
- Gallup, NM
National Provider Identifier
1518995950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 95-PA13
- Practice address
- 516 E. Nizhoni Blvd.
Gallup, NM 87301-1337 - Phone
- (505) 722-1000
- Fax
- (505) 726-8740
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 95-PA13 | NM | Primary |
Addresses
Primary practice location
516 E. Nizhoni Blvd.
Gallup, NM 87301-1337
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000S3344 | Medicaid | NM | |
| 419087 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95-PA13 | NM | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227484800000",
"number": "1518995950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1337",
"city": "GALLUP",
"state": "NM",
"postal_code": "873051337",
"telephone_number": "505-722-1000",
"fax_number": "505-726-8740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 E. NIZHONI BLVD.",
"city": "GALLUP",
"state": "NM",
"postal_code": "873011337",
"telephone_number": "505-722-1000",
"fax_number": "505-726-8740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRZYMOWSKI",
"first_name": "SUSAN",
"middle_name": "A",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2008-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "95-PA13",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000S3344",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "419087",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.