Provider Demographics
NPI:1275142648
Name:DEXTER, KATIJANE CROWE (CNP)
Entity Type:Individual
Prefix:MS
First Name:KATIJANE
Middle Name:CROWE
Last Name:DEXTER
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 1:1201 CAMINO DE SALUD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4517
Mailing Address - Country:US
Mailing Address - Phone:505-917-1022
Mailing Address - Fax:
Practice Address - Street 1:1905 SILVER AVE SE APT B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4051
Practice Address - Country:US
Practice Address - Phone:505-917-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60952363LF0000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily