Healthcare Provider Details

I. General information

NPI: 1053776708
Provider Name (Legal Business Name): MATTHEW EMERSON KAISER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N 13TH ST
ARTESIA NM
88210
US

IV. Provider business mailing address

702 N 13TH ST
ARTESIA NM
88210-1166
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-3119
  • Fax: 575-748-8524
Mailing address:
  • Phone: 575-746-3119
  • Fax: 575-748-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007593
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2018-0044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: