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General NPI Number Information
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NPI Number | 1720890452
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Entity Type | Organization
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Legal Business Name | TEEKEES CLINIC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 195 MORRISON DRIVE
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City | BOSQUE FARMS
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State | NM
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Zip | 87068
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Country | US
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Telephone | 575-215-3227
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Fax |
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Provider Business Mailing Address
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Address Line | 2260 E LOHMAN AVE
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City | LAS CRUCES
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State | NM
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Zip | 88001-8490
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Country | US
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Telephone | 575-215-3227
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Fax |
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Authorized Official
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Title or Position | SERVICES DIRECTOR
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Name | LAURA MEDINA
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Credential |
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Telephone | 915-208-6037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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