Individual
KATHRYN DEARING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
224 W DL INGRAM BLVD, BLDG 1408, CANNON AFB, NM 88103
(575) 904-3874
Mailing address
224 W DL INGRAM BLVD, BLDG 1408, CANNON AFB, NM 88103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1975
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025715000
—
NE
05
—
10026480112
—
NE
05
—
1518325190
—
IA
Enumeration date
02/10/2016
Last updated
11/07/2022
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