1508806266 NPI number — KATHLEEN M ADAMS CRNA

Table of content: KATHLEEN M ADAMS CRNA (NPI 1508806266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508806266 NPI number — KATHLEEN M ADAMS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508806266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2442 CERRILLOS RD
Provider Second Line Business Mailing Address:
#311
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-3262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-470-2388
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-325-5011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R32428 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40409252 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: T0283 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508806266 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91958237 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM009F03 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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