Basic Information
Provider Information
NPI: 1891304523
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEMPHILL
FirstName: ALLISON
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 26666
Address2: PROVIDER ENROLLMENT
City: ALBUQUERQUE
State: NM
PostalCode: 871256666
CountryCode: US
TelephoneNumber: 5059236770
FaxNumber: 5059235354
Practice Location
Address1: 201 CEDAR ST SE STE 5630
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 87106
CountryCode: US
TelephoneNumber: 5055636399
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/28/2020
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WC0200XRN-79139NMN Nursing Service ProvidersRegistered NurseCritical Care Medicine
363LA2100X60936NMN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363L00000X60936NMY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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