Healthcare Provider Details

I. General information

NPI: 1972863306
Provider Name (Legal Business Name): KATHEY PHOENIX-DOYLE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SAN PABLO ST SE
ALBUQUERQUE NM
87108-3103
US

IV. Provider business mailing address

209 SAN PABLO ST SE
ALBUQUERQUE NM
87108-3103
US

V. Phone/Fax

Practice location:
  • Phone: 505-944-7224
  • Fax: 505-944-7229
Mailing address:
  • Phone: 505-944-7224
  • Fax: 505-944-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: