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General NPI Number Information
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NPI Number | 1053279380
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Entity Type | Individual
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Provider Name | KALIE FAIRCLOUGH NP
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Gender | Female
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 3485 NORTHRISE DR
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City | LAS CRUCES
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State | NM
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Zip | 88011-6839
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Country | US
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Telephone | 575-382-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 CHIMNEY ROCK RD
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City | LAS CRUCES
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State | NM
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Zip | 88011-8654
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Country | US
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Telephone | 575-637-8953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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