Petroglyph Primary Care and Consulting LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PETROGLYPH PRIMARY CARE AND CONSULTING LLC

Doing business as

Petroglyph Primary Care

Practice address

525 Chavez St
Las Vegas, NM 87701-3221

Phone

(505) 819-8434

NPI assigned

Aug 17, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael M Archuleta, DNP, APRN, AGACNP-BC

Title

Nurse Practitioner

Phone

(505) 502-4401

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Petroglyph Primary Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705104000000",
    "number": "1891578340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6512 PATO RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871207007",
            "telephone_number": "505-502-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 CHAVEZ ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013221",
            "telephone_number": "505-819-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETROGLYPH PRIMARY CARE AND CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A",
        "authorized_official_last_name": "ARCHULETA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "505-502-4401",
        "authorized_official_credential": "DNP, APRN, AGACNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70802777",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petroglyph Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petroglyph Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Nurse Practitioner in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Primary Care Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.