Provider Demographics
NPI:1508806266
Name:ADAMS, KATHLEEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2442 CERRILLOS RD
Mailing Address - Street 2:#311
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3262
Mailing Address - Country:US
Mailing Address - Phone:505-470-2388
Mailing Address - Fax:
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-325-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32428367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40409252Medicaid
UTT0283Medicaid
AZ1508806266Medicaid
CO91958237Medicaid
NMNM009F03OtherBCBS
AZ1508806266Medicaid
NMNM009F03OtherBCBS