Healthcare Provider Details

I. General information

NPI: 1518341759
Provider Name (Legal Business Name): KAREN ELIZABETH KIRST-MILLSPAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ELIZABETH KIRST-MILLSPAUGH ANP

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E. ALLEN AYERS RD.
ESTANCIA NM
87016
US

IV. Provider business mailing address

209 E. ALLEN AYERS ROAD
ESTANCIA NM
87016
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 Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP10400
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: