Provider Demographics
NPI:1518341759
Name:KIRST-MILLSPAUGH, KAREN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:KIRST-MILLSPAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:KIRST-MILLSPAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:209 E. ALLEN AYERS ROAD
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016
Mailing Address - Country:US
Mailing Address - Phone:505-384-2711
Mailing Address - Fax:505-384-0240
Practice Address - Street 1:209 E. ALLEN AYERS RD.
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016
Practice Address - Country:US
Practice Address - Phone:505-384-2711
Practice Address - Fax:505-384-0240
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP10400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM261QP2400XOtherTAXONOMIES