Provider Demographics
NPI:1053776708
Name:KAISER, MATTHEW EMERSON (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EMERSON
Last Name:KAISER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1166
Mailing Address - Country:US
Mailing Address - Phone:575-746-3119
Mailing Address - Fax:575-748-8524
Practice Address - Street 1:702 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-746-3119
Practice Address - Fax:575-748-8524
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007593363A00000X
NMPA2018-0044363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601007593OtherMI PA LICENSE PERMANENT ID
MI1130317OtherNCCPA ID
NMPA2018-0044OtherNM PA LICENCING BOARD