Provider Demographics
NPI:1083243711
Name:ABEYTA, NICOLE KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PRESBYTERIAN HEALTHCARE SERVICES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-272-6607
Mailing Address - Fax:505-272-8045
Practice Address - Street 1:3630 LAS ESTANCIAS DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5504
Practice Address - Country:US
Practice Address - Phone:505-462-7777
Practice Address - Fax:505-462-7726
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2023-1014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program