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General NPI Number Information
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NPI Number | 1427474568
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Entity Type | Individual
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Provider Name | MIKI R MOFFITT RN, BSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 102 LLANO ST
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City | AZTEC
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State | NM
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Zip | 87410-2172
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Country | US
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Telephone | 505-334-3404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844088
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City | DALLAS
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State | TX
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Zip | 75284-4088
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Country | US
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Telephone | 505-334-3404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R41419
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 85672
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License Number State | NM
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