MEDICARE: KSG FIRST ASSISTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R58667	NM

General Provider Information

NPI Number	:	1881907632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KSG FIRST ASSISTANTS

Provider Business Mailing Address
First Line	:	4663 DEL NORTE CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6924
Country	:	US
Telephone Number	:	575-921-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4663 DEL NORTE CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6924
Country	:	US
Telephone Number	:	575-921-8554
Fax Number	:

Authorized Official
Title or Position	:	REGISTEREDNURSE FIRST ASSISTANT
Name	:	KATHLEEN SUZANNE GARZA
Credential	:	RNFA, MSN
Telephone Number	:	575-921-8554

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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