Provider Demographics
NPI:1043734411
Name:MCCLESKEY, LAURA KRIS (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KRIS
Last Name:MCCLESKEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:KRIS
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3751 SOUTHERN BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4291
Mailing Address - Country:US
Mailing Address - Phone:505-306-2293
Mailing Address - Fax:
Practice Address - Street 1:3751 SOUTHERN BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-306-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03323363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-03323OtherNEW MEXICO BOARD OF NURSING CNP LICENSE NUMBER