Provider Demographics
NPI:1275133357
Name:MCKILLIP-HEARD, AUDRA (CNM)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:MCKILLIP-HEARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 MIDNIGHT VISTA AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4380
Mailing Address - Country:US
Mailing Address - Phone:505-507-5072
Mailing Address - Fax:
Practice Address - Street 1:5027 MIDNIGHT VISTA AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4380
Practice Address - Country:US
Practice Address - Phone:505-507-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM794367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife