Elite Aesthetics

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ELITE AESTHETICS

Doing business as

Elite Dermatology

Practice address

1005 S Telshor Blvd Ste a
Las Cruces, NM 88011-4879

Phone

(575) 262-7546

Fax

(575) 888-2273

NPI assigned

Aug 12, 2019

Last updated

Dec 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristin Autry

Title

Manager

Phone

(707) 770-9990

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elite Dermatology Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• Direct secure messaging: tautry@elitederm.emadirect.md

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany Kayla Autry, DNP FNP MEP-C

  • Dermatology Physician
  • Las Cruces, NM
  • NPI 1003389875

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1902452360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 871",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880040871",
            "telephone_number": "409-719-8846",
            "fax_number": "575-888-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 S TELSHOR BLVD STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114879",
            "telephone_number": "575-262-7546",
            "fax_number": "575-888-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "AUTRY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "707-770-9990"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10222880",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tautry@elitederm.emadirect.md",
            "affiliation": "N",
            "address_1": "1005 S Telshor Blvd Ste A",
            "city": "Las Cruces",
            "state": "NM",
            "country_code": "US",
            "postal_code": "880114879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Elite Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Elite House Calls LLC
• Elite Lymphedema and Laser Institute LLC

• Dermatology Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.