Healthcare Provider Details

I. General information

NPI: 1033125828
Provider Name (Legal Business Name): K & L ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 W MAPLE ST
FARMINGTON NM
87401-5968
US

IV. Provider business mailing address

656 W MAPLE STREET
FARMINGTON NM
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-2206
  • Fax: 505-325-4969
Mailing address:
  • Phone: 505-327-2206
  • Fax: 505-325-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMD2003-0686
License Number StateNM

VIII. Authorized Official

Name: DR. KENNETH DALE SLACK
Title or Position: PRESIDENT
Credential: MD.
Phone: 505-327-2206