Healthcare Provider Details

I. General information

NPI: 1609807833
Provider Name (Legal Business Name): KELLY DIANE WAUGAMAN AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY HEYMAN AUD

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALIENTE RD STE 5A
SANTA FE NM
87508-9102
US

IV. Provider business mailing address

5 CALIENTE RD STE 5A
SANTA FE NM
87508-9102
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-7526
  • Fax: 505-466-7528
Mailing address:
  • Phone: 505-466-7526
  • Fax: 505-466-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3966
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD3966
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: