Provider Demographics
NPI:1003388190
Name:PFEIFFER, KELLY VAN
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:VAN
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 N LOVINGTON HWY STE 550
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1171
Mailing Address - Country:US
Mailing Address - Phone:575-964-8025
Mailing Address - Fax:575-291-3009
Practice Address - Street 1:3900 N LOVINGTON HWY STE 550
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1171
Practice Address - Country:US
Practice Address - Phone:575-738-0051
Practice Address - Fax:575-291-3009
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily