Provider Demographics
NPI:1922452960
Name:CERA, KAILEIGH (CNP)
Entity Type:Individual
Prefix:
First Name:KAILEIGH
Middle Name:
Last Name:CERA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ZAFARANO DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2669
Mailing Address - Country:US
Mailing Address - Phone:505-466-5885
Mailing Address - Fax:
Practice Address - Street 1:3450 ZAFARANO DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2669
Practice Address - Country:US
Practice Address - Phone:505-466-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily