Provider Demographics
NPI:1346645744
Name:KLEISMIT, ERIN (CNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KLEISMIT
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 1:1302 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7215
Mailing Address - Country:US
Mailing Address - Phone:575-538-4112
Mailing Address - Fax:575-388-1791
Practice Address - Street 1:1302 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7215
Practice Address - Country:US
Practice Address - Phone:575-538-4112
Practice Address - Fax:575-388-1791
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.205419163W00000X
OHCOA.16756-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0119429Medicaid
OH0119429Medicaid