Healthcare Provider Details

I. General information

NPI: 1801670658
Provider Name (Legal Business Name): KAYLA LEE ANN PATTERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1500 N RENAISSANCE BLVD NE STE C
ALBUQUERQUE NM
87107-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1125
  • Fax: 505-724-6125
Mailing address:
  • Phone: 505-266-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: