Individual
KYLE DEISIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
PO BOX 133, ANGEL FIRE, NM 87710-0133
(575) 377-3301
Mailing address
41 LAGUNA RD, EAGLE NEST, NM 87718-9003
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
66201
NM
363LA2100X
Acute Care Nurse Practitioner
66201
NM
Other
Enumeration date
11/22/2024
Last updated
12/05/2024
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