Healthcare Provider Details

I. General information

NPI: 1700676343
Provider Name (Legal Business Name): JOAN KAY YODER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ROAD 6185
KIRTLAND NM
87417-9323
US

IV. Provider business mailing address

20 ROAD 6185
KIRTLAND NM
87417-9323
US

V. Phone/Fax

Practice location:
  • Phone: 505-716-8070
  • Fax:
Mailing address:
  • Phone: 505-716-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: