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NPI Code Detail

MEDICARE: KRISTIE LYNN AVON DNP, AGACNP-BC, APRN

MEDICARE: KRISTIE LYNN AVON DNP, AGACNP-BC, APRN
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
1363LA2100XAcute Care Nurse Practitioner85745NM

General Provider Information

NPI Number : 1063397289
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE LYNN AVON DNP, AGACNP-BC, APRN
Provider Business Mailing Address
First Line : 1619 SKYLINE CIR STE A
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-9842
Country : US
Telephone Number : 575-941-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1619 SKYLINE CIR STE A
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-9842
Country : US
Telephone Number : 575-941-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2025
Last Update Date : 10/08/2025

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