Healthcare Provider Details

I. General information

NPI: 1093695645
Provider Name (Legal Business Name): KATIE HEITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005-3280
US

IV. Provider business mailing address

3100 OAK ST
LAS CRUCES NM
88005-3769
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-2288
  • Fax: 575-523-2299
Mailing address:
  • Phone: 575-523-2288
  • Fax: 575-523-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20260941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: