Provider Demographics
NPI:1952165235
Name:VIETH, KRISSA (NP)
Entity Type:Individual
Prefix:DR
First Name:KRISSA
Middle Name:
Last Name:VIETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISSA
Other - Middle Name:
Other - Last Name:DEXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8291
Mailing Address - Country:US
Mailing Address - Phone:575-405-4062
Mailing Address - Fax:
Practice Address - Street 1:1130 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8291
Practice Address - Country:US
Practice Address - Phone:575-405-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76467363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics