Provider Demographics
NPI:1023380615
Name:THATCHER, KATHERINE M (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:THATCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-5407
Mailing Address - Country:US
Mailing Address - Phone:575-623-3255
Mailing Address - Fax:575-625-9901
Practice Address - Street 1:106 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-3042
Practice Address - Country:US
Practice Address - Phone:575-973-8543
Practice Address - Fax:575-578-1901
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01930363LF0000X
NMCNP01930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67478069Medicaid