Healthcare Provider Details

I. General information

NPI: 1124889894
Provider Name (Legal Business Name): ANNIE KING LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRANKLIN AVE UNIT 6
SANTA FE NM
87501-3617
US

IV. Provider business mailing address

PO BOX 34091
SANTA FE NM
87594-4091
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-2043
  • Fax: 505-395-2915
Mailing address:
  • Phone: 505-385-2043
  • Fax: 505-395-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberCAT0145921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: