Healthcare Provider Details

I. General information

NPI: 1487217782
Provider Name (Legal Business Name): M&K HEALTH CARE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 JAGER DR NE STE C
RIO RANCHO NM
87144-7527
US

IV. Provider business mailing address

4351 JAGER DR NE STE C
RIO RANCHO NM
87144-7527
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-4377
  • Fax: 505-485-0555
Mailing address:
  • Phone: 505-867-4377
  • Fax: 505-485-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RAY
Title or Position: OWNER
Credential: FNP-BC
Phone: 505-867-4377