Healthcare Provider Details

I. General information

NPI: 1902745268
Provider Name (Legal Business Name): KAY-MANI RIELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 K 2 BUFFALO TRAIL ROAD
PENASCO NM
87553
US

IV. Provider business mailing address

PO BOX 127
PENASCO NM
87553-0127
US

V. Phone/Fax

Practice location:
  • Phone: 505-927-0918
  • Fax: 833-438-5215
Mailing address:
  • Phone: 505-927-0918
  • Fax: 833-438-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: