Provider Demographics
NPI:1669801858
Name:JEFFCOAT-KNAUER, KRISTEN (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JEFFCOAT-KNAUER
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4154
Mailing Address - Country:US
Mailing Address - Phone:575-935-9000
Mailing Address - Fax:575-935-1002
Practice Address - Street 1:1521 W 13TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5568
Practice Address - Country:US
Practice Address - Phone:575-769-0888
Practice Address - Fax:575-763-9154
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP02288363LP0200X
NMGP-01143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine