| NPI | 1063989648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH B WINFREY Owner 505-663-6645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2024-06-27 |