Individual
KYLE MATHEW PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
1131 PACAYA DR NW, ALBUQUERQUE, NM 87120-1064
(618) 225-0996
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
T-22007
NM
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/11/2023
Last updated
10/23/2024
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