Healthcare Provider Details

I. General information

NPI: 1700751815
Provider Name (Legal Business Name): MORGAN KENNEDY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 MESA GRANDE LOOP NE
RIO RANCHO NM
87144-0571
US

IV. Provider business mailing address

1936 MESA GRANDE LOOP NE
RIO RANCHO NM
87144-0571
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-9007
  • Fax:
Mailing address:
  • Phone:
  • 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: