Provider Demographics
NPI:1558865980
Name:GUERRA, KIRSTEN SHELBY (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:SHELBY
Last Name:GUERRA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 E. LOHMAN AVE ., SUITE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8255
Mailing Address - Country:US
Mailing Address - Phone:575-532-9077
Mailing Address - Fax:575-532-9221
Practice Address - Street 1:4401 E. LOHMAN AVE ., SUITE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-532-9077
Practice Address - Fax:575-532-9221
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03538363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics