Angela M Kisner, DOM, FNP-CB, BSN-RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

54175 Issued in NM

Practice address

1501 San Pedro Dr SE
Albuquerque, NM 87108-5154

Phone

(505) 265-1711

NPI assigned

Jun 25, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Angela Marie Frederick Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1609004910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9805 RIO CORTO AVE SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871212628",
            "telephone_number": "505-803-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SAN PEDRO DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871085154",
            "telephone_number": "505-265-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2527 Wyoming Blvd NE",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871121039",
            "country_code": "US",
            "telephone_number": "505-803-3623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISNER",
        "first_name": "ANGELA",
        "middle_name": "M",
        "credential": "DOM, FNP-CB, BSN-RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NM",
            "license": "992",
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "NM",
            "license": "54175",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "54175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ANGELA.KISNER@VA.GOV",
            "affiliation": "N",
            "endpointDescription": "HOSPITAL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1501 San Pedro Dr SE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871085154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "FREDERICK",
            "middle_name": "MARIE",
            "credential": "DOM, FNP-CB, BSN-RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Kirsch
• Cynthia Ann Kirschenman, RN
• Courtney Kirschman
• Kirtland Family Dentistry LLC
• Nicole Marie Kiselicka-Sickmiller, BCABA
• Mallory A Kisner, MA
• Adam Kiss, SW
• Anna Kistin, MD
• Martin Kistin, MD
• Naomi J Kistin, MD, MPH

• Family Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.