Healthcare Provider Details

I. General information

NPI: 1346645744
Provider Name (Legal Business Name): ERIN KLEISMIT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E 32ND ST
SILVER CITY NM
88061-7215
US

IV. Provider business mailing address

1302 E 32ND ST
SILVER CITY NM
88061-7215
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-4112
  • Fax: 575-388-1791
Mailing address:
  • Phone: 575-538-4112
  • Fax: 575-388-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.205419
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP143695
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.16756-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: