Healthcare Provider Details

I. General information

NPI: 1609873355
Provider Name (Legal Business Name): MARCIA LOUISE HEFKER PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/13/2025
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S 2ND STREET
RATON NM
87740
US

IV. Provider business mailing address

8206 LOUISIANA BLVD, STE A 1701
ALBUQUERQUE NM
87113
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-3020
  • Fax: 505-212-5265
Mailing address:
  • Phone: 505-225-3020
  • Fax: 505-212-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00722
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34642
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP00722
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: