Healthcare Provider Details

I. General information

NPI: 1013922582
Provider Name (Legal Business Name): KAYLENE SHARON MCCOLLUM APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON KAYLENE MURPHY

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY PRACTICE CTR 2400 TUCKER NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8043
  • Fax: 505-272-8044
Mailing address:
  • Phone: 505-272-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00452
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: