Healthcare Provider Details

I. General information

NPI: 1437040235
Provider Name (Legal Business Name): KELLY JOELLE TAFOYA-DOMINGUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 HIGH ASSETS WAY NW STE 8
ALBUQUERQUE NM
87120-5115
US

IV. Provider business mailing address

9101 HIGH ASSETS WAY NW STE 8
ALBUQUERQUE NM
87120-5115
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-3050
  • Fax:
Mailing address:
  • Phone: 505-261-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-202633
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: