Healthcare Provider Details

I. General information

NPI: 1871262956
Provider Name (Legal Business Name): KAYLA E MCMINN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA E ATWOOD RN

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N BUTLER AVE
FARMINGTON NM
87401-6355
US

IV. Provider business mailing address

3109 CRESTRIDGE DR
FARMINGTON NM
87401-9330
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8607
  • Fax:
Mailing address:
  • Phone: 505-330-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-84396
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: