Healthcare Provider Details

I. General information

NPI: 1669801858
Provider Name (Legal Business Name): KRISTEN JEFFCOAT-KNAUER RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W 13TH ST
CLOVIS NM
88101-5568
US

IV. Provider business mailing address

912 W 21ST ST
CLOVIS NM
88101-4154
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-0888
  • Fax: 575-763-9154
Mailing address:
  • Phone: 575-935-9000
  • Fax: 575-935-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP02288
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGP-01143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: