Healthcare Provider Details

I. General information

NPI: 1083243711
Provider Name (Legal Business Name): NICOLE KRISTINE ABEYTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 09/19/2023
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 LAS ESTANCIAS DR SW
ALBUQUERQUE NM
87121-5504
US

IV. Provider business mailing address

PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICES
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7777
  • Fax: 505-462-7726
Mailing address:
  • Phone: 505-272-6607
  • Fax: 505-272-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-1014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: