Individual
LAUREN MACCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-4799
(058) 463-2005
Mailing address
4532 AGATE HILLS RD NW, ALBUQUERQUE, NM 87114-5379
(252) 367-5757
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
79755
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/10/2021
Last updated
07/09/2024
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