Healthcare Provider Details

I. General information

NPI: 1275483570
Provider Name (Legal Business Name): KATHRYN I FEARNSIDE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COORS BLVD NW
ALBUQUERQUE NM
87120-1292
US

IV. Provider business mailing address

1113 BRYN MAWR DR NE
ALBUQUERQUE NM
87106-2003
US

V. Phone/Fax

Practice location:
  • Phone: 505-652-4002
  • Fax:
Mailing address:
  • Phone: 505-331-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN-69482
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN-69482
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: