Healthcare Provider Details

I. General information

NPI: 1851207534
Provider Name (Legal Business Name): WINTER LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE SE
ALBUQUERQUE NM
87102-3656
US

IV. Provider business mailing address

818 SMOKY BAY WAY STE 414
HOMER AK
99603-7653
US

V. Phone/Fax

Practice location:
  • Phone: 907-531-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. HAYLEY WALTERS
Title or Position: OWNER
Credential:
Phone: 505-879-4308