Healthcare Provider Details

I. General information

NPI: 1104700152
Provider Name (Legal Business Name): MEGAN KINLER AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADMOOR BLVD NE
RIO RANCHO NM
87144-2100
US

IV. Provider business mailing address

641 PLAYFUL MEADOWS DR NE
RIO RANCHO NM
87144-4094
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-5402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number90748
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number86924
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: