MEDICARE: KATHRYN M. AUTREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	427	NM
2	367A00000X	Advanced Practice Midwife	AP129827	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013919257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M. AUTREY

Provider Business Mailing Address
First Line	:	2520 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4907
Country	:	US
Telephone Number	:	575-522-9793
Fax Number	:	575-532-9019

Provider Business Practice Location Address
First Line	:	12174 N MOPAC EXPY STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2910
Country	:	US
Telephone Number	:	512-994-2662
Fax Number	:	512-406-6202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/11/2018

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Directions to “ KATHRYN M. AUTREY ” Practice Location

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