Provider Demographics
NPI:1275013922
Name:STEVENS, KATHLEEN A (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8616
Mailing Address - Country:US
Mailing Address - Phone:575-521-0055
Mailing Address - Fax:575-521-0077
Practice Address - Street 1:2800 DORAL CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8616
Practice Address - Country:US
Practice Address - Phone:575-521-0055
Practice Address - Fax:575-521-0077
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53703363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care