Individual provider Active NPI

Kerry Atkinson, CNP

  • Nurse Practitioner
  • Las Cruces, NM
National Provider Identifier
1174981690
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP-02837 Issued in NM
Practice address
2450 S Telshor Blvd
Las Cruces, NM 88011-5141
Phone
(575) 522-8641
NPI assigned
Jan 29, 2016
Last updated
Oct 31, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP-02837 NM Primary

Addresses

Primary practice location

2450 S Telshor Blvd
Las Cruces, NM 88011-5141

Mailing address

PO Box 13580
Las Cruces, NM 88013-3580
Phone (575) 556-5960

Other identifiers 1

IdentifierTypeStateIssuer
97757560MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160408001026 NM Practitioner - Nurse Practitioner 0648578534 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PHC-Las Cruces IncGroup PAC ID 4486635802, 22 clinicians

Practice addresses (Care Compare)

2450 S Telshor Blvd
Las Cruces, NM 88011-5069
Phone (575) 556-6550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP-02837NMMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
PHC-Las Cruces Inc Nurse Practitioner Current Accepting new patients
PHC Las Cruces Inc. CurrentSince Jun 26, 2017 Accepting new patients
Southwest Emergency Medical Associates of NM PC Nurse Practitioner CurrentSince Sep 1, 2017 Accepting new patients
Neurology Associates of Mesilla Valley PC CurrentSince Feb 17, 2016 Accepting new patients
PHC Las Cruces Inc CurrentSince Jun 26, 2017 Accepting new patients
Northwest Hospital Medicine Physicians LLC Nurse Practitioner CurrentSince Nov 1, 2016 Accepting new patients

Locations

5000 Hopyard Rd
Ste 100
Pleasanton, CA 94588
Phone (800) 617-7717

2450 S Telshor Blvd
Las Cruces, NM 88011
Phone (505) 522-8641

2450 S Telshor Blvd
Ste B
Las Cruces, NM 88011
Phone (575) 556-5800

2735 Northrise Dr
Las Cruces, NM 88011
Phone (505) 532-4344

3855 Foothills Rd
Las Cruces, NM 88011
Phone (575) 526-3625

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1174981690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13580",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880133580",
            "telephone_number": "575-556-5960",
            "fax_number": "575-556-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 S TELSHOR BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880115141",
            "telephone_number": "575-522-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATKINSON",
        "first_name": "KERRY",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-29",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-02837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97757560",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.