MEDICARE: DR. KRISTY L SCULLION-MCPHERSON PHD

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	103T00000X	Psychologist	1013	NM

General Provider Information

NPI Number	:	1508934019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTY L SCULLION-MCPHERSON PHD

Provider Business Mailing Address
First Line	:	2922 SUNDOWN RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4612
Country	:	US
Telephone Number	:	505-642-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 E LOHMAN AVE
Second Line	:	STE 34
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	505-642-7200
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/29/2007

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