Provider Demographics
NPI:1003389875
Name:AUTRY, TIFFANY KAYLA (DNP FNP)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:KAYLA
Last Name:AUTRY
Suffix:
Gender:F
Credentials:DNP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-0871
Mailing Address - Country:US
Mailing Address - Phone:409-719-8846
Mailing Address - Fax:575-888-2273
Practice Address - Street 1:1005 S TELSHOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4879
Practice Address - Country:US
Practice Address - Phone:575-262-7546
Practice Address - Fax:575-888-2273
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54435207Q00000X
NM544355207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty