Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 544355 | NM |
N | 207Q00000X | Family Doctor | 54435 | NM |
NPI | 1003389875 |
---|---|
Provider Name | Dr. Tiffany Kayla Autry |
First Address | Las Cruces, NM 88004-2845 |
Second Address | Las Cruces, NM 88005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2019 |
Last Update Date | 12/08/2019 |