Healthcare Provider Details

I. General information

NPI: 1538282413
Provider Name (Legal Business Name): PATRICIA ANN MCKAY D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MOON ST NE STE 14
ALBUQUERQUE NM
87112-3972
US

IV. Provider business mailing address

2424 PLAZA VIZCAYA NW
ALBUQUERQUE NM
87104-2936
US

V. Phone/Fax

Practice location:
  • Phone: 505-459-7473
  • Fax: 505-268-8705
Mailing address:
  • Phone: 505-459-7473
  • Fax: 505-268-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number354
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: