Provider Demographics
NPI:1881726388
Name:RABURN, KAREN LESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LESLEY
Last Name:RABURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LESLEY
Other - Last Name:RABURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:102 E HIGH
Mailing Address - Street 2:BOX 881
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-0881
Mailing Address - Country:US
Mailing Address - Phone:575-461-6200
Mailing Address - Fax:575-461-0404
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:BOX 881
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:575-461-6200
Practice Address - Fax:575-461-0404
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-3882084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00646Medicaid
NM321302Medicare UPIN