Provider Demographics
NPI:1144217787
Name:VAILLANT, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VAILLANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 SEDONA HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4138
Mailing Address - Country:US
Mailing Address - Phone:575-626-8400
Mailing Address - Fax:
Practice Address - Street 1:141 N ROADRUNNER PKWY STE 224
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-2001
Practice Address - Country:US
Practice Address - Phone:575-524-8888
Practice Address - Fax:575-524-8132
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001370OtherBCBS
NMH6266Medicaid
NMG20584Medicare UPIN
NM080181771Medicare PIN