Provider Demographics
NPI:1780629675
Name:ATKISON, NORMA J (PA-C)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:ATKISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2813
Mailing Address - Country:US
Mailing Address - Phone:575-396-6611
Mailing Address - Fax:575-396-1454
Practice Address - Street 1:204 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:NM
Practice Address - Zip Code:88267-9802
Practice Address - Country:US
Practice Address - Phone:575-398-2111
Practice Address - Fax:575-396-1454
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-PA12363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89339762Medicaid
NM89339762Medicaid