ANGELA M KISNER DOM, FNP-CB, BSN-RN
NPI 1609004910
Nurse Practitioner - Family in Albuquerque, NM

Q: What is Angela Kisner's NPI number?

The NPI number for Angela Kisner is 1609004910. It was assigned to this individual provider in the NPPES registry on June 25, 2009. The provider is also known as Angela Marie Frederick Dom, Fnp-Cb, Bsn-Rn.

Q: What is Angela Kisner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Angela Kisner was last updated on March 11, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 25, 2009PECOS Enrolled

1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108(505) 265-1711 Get Directions Write a Review

NPPES record last updated: March 11, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Angela M Kisner Dom, Fnp-cb, Bsn-rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANGELA M KISNER DOM, FNP-CB, BSN-RN (NPI 1609004910) is an individual family provider in Albuquerque, New Mexico, licensed in New Mexico (54175) and active in the NPI registry since June 2009. She is enrolled in Medicare PECOS and maintains a secondary practice location in Albuquerque.

NPPES Registry Identity

NPI1609004910

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameANGELA M KISNERCredential: DOM, FNP-CB, BSN-RN

Location Address1501 SAN PEDRO DR SEAlbuquerque, NM 87108-5154

Mailing Address9805 Rio Corto Ave SwAlbuquerque, NM 87121-2628 · (505) 803-3623

Phone(505) 265-1711

Sole ProprietorYes

Enumeration DateJune 25, 2009

Last NPPES UpdateMarch 11, 2022

NPPES CertifiedMarch 11, 2022

✔ NPI 1609004910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in NM · 54175

Also ListedAcupuncturistTaxonomy 171100000X · License 992 (NM)

Also ListedClinic/Center · VATaxonomy 261QV0200X · License 54175 (NM)

1501 SAN PEDRO DR SE, Albuquerque, NM 87108

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Other Names 1

Former Name (1)Angela Marie Frederick Dom, Fnp-cb, Bsn-rn

Secondary Practice Location 1

Location 12527 Wyoming Blvd NE, Suite AAlbuquerque, NM 87112-1039 · Phone (505) 803-3623

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Angela M Kisner Dom, Fnp-cb, Bsn-rn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87108 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.79 typical visit price

range $54.26 – $166.80

Typical copayment $21.19 (range $13.56 – $41.70)

Most-billed visit code 99203

Established Patient

$96.38 typical visit price

range $17.00 – $135.35

Typical copayment $24.09 (range $4.25 – $33.83)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMANDA P SAMPSON PHARMD

Pharmacist