Provider Demographics
NPI:1033624887
Name:HALVORSON-KELLEY, LINDA JEAN (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:HALVORSON-KELLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 CHERRY HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1077
Mailing Address - Country:US
Mailing Address - Phone:505-400-1045
Mailing Address - Fax:
Practice Address - Street 1:11601 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2660
Practice Address - Country:US
Practice Address - Phone:505-814-6926
Practice Address - Fax:505-237-8634
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR43414363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily