Healthcare Provider Details

I. General information

NPI: 1154618411
Provider Name (Legal Business Name): KATHERINE EMERICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MISSOURI AVE SUITE # 12
LAS CRUCES NM
88011-5075
US

IV. Provider business mailing address

2801 MISSOURI AVE SUITE # 12
LAS CRUCES NM
88011-5075
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-9433
  • Fax: 575-522-8891
Mailing address:
  • Phone: 575-649-9433
  • Fax: 575-522-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01746
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: