MEDICARE: DR. MARCIA LOUISE HEFKER PMHNP-BC, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CNP00722	NM
2	363LF0000X	Family Nurse Practitioner	R34642	NM
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP00722	NM

General Provider Information

NPI Number	:	1609873355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCIA LOUISE HEFKER PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	8206 LOUISIANA BLVD, STE A 1701
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113
Country	:	US
Telephone Number	:	505-225-3020
Fax Number	:	505-212-5265

Provider Business Practice Location Address
First Line	:	1400 S 2ND STREET
Second Line	:
City	:	RATON
State	:	NM
Zip	:	87740
Country	:	US
Telephone Number	:	505-225-3020
Fax Number	:	505-212-5265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/13/2025

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