Healthcare Provider Details

I. General information

NPI: 1508570243
Provider Name (Legal Business Name): TWYLASTAR K LUARKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W AZTEC AVE
GALLUP NM
87301-6666
US

IV. Provider business mailing address

2500 UNIVERSITY BLVD NE APT 356
ALBUQUERQUE NM
87107-1732
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax: 866-608-5560
Mailing address:
  • Phone: 505-382-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: