Healthcare Provider Details

I. General information

NPI: 1346041647
Provider Name (Legal Business Name): ANNA L MYERS RECREATION/WELLNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA L MYERS

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 KALGAN RD NE
RIO RANCHO NM
87144-3547
US

IV. Provider business mailing address

6271 KALGAN RD NE
RIO RANCHO NM
87144-3547
US

V. Phone/Fax

Practice location:
  • Phone: 816-332-0536
  • Fax:
Mailing address:
  • Phone: 816-332-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: