Basic Information
| Provider Information | |||||||||
| NPI: | 1003026279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATHEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | DNP, C-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 ENTERPRISE RD | ||||||||
| Address2: | |||||||||
| City: | SOCORRO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 878014199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758354444 | ||||||||
| FaxNumber: | 5755244266 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 ENTERPRISE RD | ||||||||
| Address2: | |||||||||
| City: | SOCORRO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 878014199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758354444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 209005068 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | CNP-02940 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.