Healthcare Provider Details

I. General information

NPI: 1316872658
Provider Name (Legal Business Name): ASHLEY ABEYTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 9T ST NW
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

4105 9T ST NW
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-917-1830
  • Fax:
Mailing address:
  • Phone: 505-917-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number27079740A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: