Provider Demographics
NPI:1891009650
Name:BEHNING, KATHERINE REILLY (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:REILLY
Last Name:BEHNING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6320 RIVERSIDE PLAZA LN NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1710
Mailing Address - Country:US
Mailing Address - Phone:505-843-6168
Mailing Address - Fax:505-792-1978
Practice Address - Street 1:1001 COAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5205
Practice Address - Country:US
Practice Address - Phone:505-843-6168
Practice Address - Fax:505-792-1978
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01650363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM60879343Medicaid
NMNMA101259Medicare PIN