Provider Demographics
NPI:1801464243
Name:BAIRNS PSYCHIATRIC GROUP LLC
Entity type:Organization
Organization Name:BAIRNS PSYCHIATRIC GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ISOLINA
Authorized Official - Last Name:KASBOHM
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-489-6171
Mailing Address - Street 1:718 10TH ST STE W
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6777
Mailing Address - Country:US
Mailing Address - Phone:575-489-6171
Mailing Address - Fax:877-838-0737
Practice Address - Street 1:718 10TH ST STE W
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6777
Practice Address - Country:US
Practice Address - Phone:575-489-6171
Practice Address - Fax:877-838-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-13
Last Update Date:2024-10-08
Deactivation Date:2024-10-01
Deactivation Code:
Reactivation Date:2024-10-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61580538Medicaid