Healthcare Provider Details

I. General information

NPI: 1720890452
Provider Name (Legal Business Name): TEEKEES CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MORRISON DRIVE
BOSQUE FARMS NM
87068
US

IV. Provider business mailing address

2260 E LOHMAN AVE
LAS CRUCES NM
88001-8490
US

V. Phone/Fax

Practice location:
  • Phone: 575-215-3227
  • Fax:
Mailing address:
  • Phone: 575-215-3227
  • 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: LAURA MEDINA
Title or Position: SERVICES DIRECTOR
Credential:
Phone: 915-208-6037