Provider Demographics
NPI:1033250329
Name:LEMONE, KATHLEEN ANN (LICENSED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:LEMONE
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14626 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6141
Mailing Address - Country:US
Mailing Address - Phone:505-636-4627
Mailing Address - Fax:505-522-8891
Practice Address - Street 1:2801 MISSOURI AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5075
Practice Address - Country:US
Practice Address - Phone:505-522-6900
Practice Address - Fax:505-522-8891
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7029 R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96864Medicaid