Provider Demographics
NPI:1790885630
Name:SIMON, KATHLEEN T (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:SIMON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-522-4767
Mailing Address - Fax:575-522-3607
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-522-4767
Practice Address - Fax:575-522-3607
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM338176B00000X
NMR36042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse