Provider Demographics
NPI:1568572451
Name:HAUSER, JIMMIE K (FNP)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:K
Last Name:HAUSER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8258
Mailing Address - Country:US
Mailing Address - Phone:575-521-8860
Mailing Address - Fax:575-522-5664
Practice Address - Street 1:4351 E LOHMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8258
Practice Address - Country:US
Practice Address - Phone:575-521-8860
Practice Address - Fax:575-522-5664
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59836521Medicaid
NM59836521Medicaid
NM59836521Medicaid