Individual provider Active NPI

Kaaren L Mahan, PA-C

  • Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1922193192
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2004-0011 Issued in NM
Practice address
2920 Carlisle Blvd NE BLDG B
Albuquerque, NM 87110-2867
Phone
(575) 973-2364
NPI assigned
Oct 4, 2006
Last updated
Apr 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2004-0011 NM Primary
Family Medicine Physician 207Q00000X PA2004-0011 NM

Addresses

Primary practice location

2920 Carlisle Blvd NE BLDG B
Albuquerque, NM 87110-2867

Mailing address

2920 Carlisle Blvd NE BLDG B
Albuquerque, NM 87110-2867
Phone (575) 973-2364

Other identifiers 1

IdentifierTypeStateIssuer
90352891MedicaidNM

Other names 1

  • Miss Kaaren L Mahan Former name

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
I20050422000028 NM Practitioner - Physician Assistant 3375596240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2920 Carlisle Blvd NE
BLDG B
Albuquerque, NM 87110-2867
Phone (575) 973-2364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: kaaren.mahan.1@33170.direct.athenahealth.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1922193192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 CARLISLE BLVD NE BLDG B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871102867",
            "telephone_number": "575-973-2364",
            "fax_number": "833-438-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 CARLISLE BLVD NE BLDG B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871102867",
            "telephone_number": "575-973-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "KAAREN",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2004-0011",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "PA2004-0011",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90352891",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAAREN",
            "last_name": "MAHAN",
            "middle_name": "L",
            "prefix": "MISS",
            "credential": "MAHAN-RISKA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.