Shane Mikesky, RD
Individual provider Active NPI Registered Dietitian · Kirtland Afb, NM
NPI 1225769730 · NPPES record last updated Feb 6, 2026
Key facts
- NPI
- 1225769730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 86174678
- Practice address
- 2050A 2ND St SE
Kirtland Afb, NM 87117-7220 - Phone
- (505) 846-3200
- NPI assigned
- Jun 23, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86174678 | Yes |
Addresses
Primary practice location
2050A 2ND St SE
Kirtland Afb, NM 87117-7220
Mailing address
3832 La Charles Dr NE
Albuquerque, NM 87111-4116
Phone (317) 650-7234
Other practice location 1
3832 La Charles Dr NE
Albuquerque, NM 87111-4116
Phone (317) 650-7234
Other providers in Kirtland Afb, NM
- Shannon Maclean
- Scott Richard Marrs
- Louis Mayer II
- Consuelo L McCash
- Christopher McLaughlin
- Adrianna Miller
- Thomas O'Neal Moore
- Adam David Myers
- Vanessa Maria Naimoli
- William James Negri
All providers in Kirtland Afb, NM · Registered Dietitian in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.