Healthcare Provider Details

I. General information

NPI: 1538866496
Provider Name (Legal Business Name): KATHERINE MELISSA PERALES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S 8TH ST STE B
DEMING NM
88030-4037
US

IV. Provider business mailing address

1740 DONA ANA RD SW
DEMING NM
88030-7767
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-7200
  • Fax:
Mailing address:
  • Phone: 915-474-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: