Healthcare Provider Details

I. General information

NPI: 1669890083
Provider Name (Legal Business Name): DESIREE NICOLE FELKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 E LOHMAN AVE SUITE 34
LAS CRUCES NM
88011-8269
US

IV. Provider business mailing address

121 ARMADILLO LN
LAS CRUCES NM
88007-5869
US

V. Phone/Fax

Practice location:
  • Phone: 575-585-9960
  • Fax: 575-525-9958
Mailing address:
  • Phone: 575-420-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7343
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: