Provider Demographics
NPI:1063397289
Name:AVON, KRISTIE LYNN (DNP, AGACNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:AVON
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SKYLINE CIR STE A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-9842
Mailing Address - Country:US
Mailing Address - Phone:575-941-4400
Mailing Address - Fax:
Practice Address - Street 1:1619 SKYLINE CIR STE A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-9842
Practice Address - Country:US
Practice Address - Phone:575-941-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85745363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care