Healthcare Provider Details

I. General information

NPI: 1215933759
Provider Name (Legal Business Name): KATHLEEN JO AUSTIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CALLE DE ALEGRA BLDG. C
LAS CRUCES NM
88005
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG. A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-7181
  • Fax: 575-521-7199
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNP00054
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: