Individual
MARK ALLEN KNEISLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
#3 ROUGEMONT LN, PECOS, NM 87552
(505) 470-0244
Mailing address
HC 74 BOX 875, PECOS, NM 87552-9515
(505) 470-0244
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
RN-83310
NM
Other
Enumeration date
08/05/2022
Last updated
08/05/2022
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