Basic Information
| Provider Information | |||||||||
| NPI: | 1780629675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATKISON | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 NORTH MAIN | ||||||||
| Address2: | |||||||||
| City: | LOVINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882602813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753966611 | ||||||||
| FaxNumber: | 5753961454 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 NORTH MAIN | ||||||||
| Address2: | |||||||||
| City: | TATUM | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882679802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753982111 | ||||||||
| FaxNumber: | 5753961454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 95-PA12 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 89339762 | 05 | NM | MEDICAID |