Healthcare Provider Details

I. General information

NPI: 1487832986
Provider Name (Legal Business Name): CORRECTIONS CORP. OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 EAST ALLEN AYERS
ESTANCIA NM
87016-0837
US

IV. Provider business mailing address

10 BURTON HILLS BLVD
NASHVILLE TN
37215-6105
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-2711
  • Fax: 505-384-0240
Mailing address:
  • Phone: 505-384-2711
  • Fax: 505-384-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License NumberR60905
License Number StateNM

VIII. Authorized Official

Name: MRS. KAREN ELIZABETH KIRST-MILLSPAUGH
Title or Position: ADULT NURSE PRACTITIONER
Credential: RN,C.,APN
Phone: 505-466-4174