Kelyn Y De Matta
Individual provider Active NPI Counselor · Fort. Sumner, NM
NPI 1861784530 · NPPES record last updated May 12, 2011
Key facts
- NPI
- 1861784530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 678 Avenue C
Fort. Sumner, NM 88119 - Phone
- (575) 355-8326
- Fax
- (575) 355-8327
- NPI assigned
- May 12, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
678 Avenue C
Fort. Sumner, NM 88119
Mailing address
PO Box 28220
Santa Fe, NM 87592-8220
Phone (505) 471-5006
Other providers in Fort. Sumner, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2011. 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.