Provider Demographics
NPI:1669332177
Name:MORNING STAR MEDICAL LLC
Entity type:Organization
Organization Name:MORNING STAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-463-1017
Mailing Address - Street 1:PO BOX 90644
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-0644
Mailing Address - Country:US
Mailing Address - Phone:505-463-1017
Mailing Address - Fax:
Practice Address - Street 1:10416 MORNING STAR DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7539
Practice Address - Country:US
Practice Address - Phone:505-463-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-17
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty