Kim G Devou, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP-01670 Issued in NM

Practice address

2301 N MLK Blvd
Clovis, NM 88101-9401

Phone

(575) 762-4455

Fax

(575) 935-5455

NPI assigned

Sep 16, 2010

Last updated

Dec 15, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clovis Family Health Care Center LLC

  • Family Medicine Physician
  • Clovis, NM
  • NPI 1760123475
  NPD (past)

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481760000000",
    "number": "1639487333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 N DR MARTIN LUTHER KING JR BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "575-762-4455",
            "fax_number": "575-935-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N MLK BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "575-762-4455",
            "fax_number": "575-935-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVOU",
        "first_name": "KIM",
        "middle_name": "G",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-16",
        "last_updated": "2016-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "CNP-01670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39778088",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Wesley Delong, PHARM.D.
• Alison Deluca, M.D.
• Abigail H Dennis
• Erin Derossitt
• Aditya Desai, DDS
• Diane C Dewitt, O.D.
• Bianca Lyzette Diaz
• Silvia Diaz, BMS
• Jennifer Nichole Dickerson, RN
• DJ2 Junctions Inc

• Psychiatric/Mental Health Nurse Practitioner in Clovis, NM
• Providers in Clovis, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.