Provider Demographics
NPI:1962942128
Name:AT YOUR DOOR MEDICAL
Entity type:Organization
Organization Name:AT YOUR DOOR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP-C
Authorized Official - Phone:575-513-7696
Mailing Address - Street 1:910 W PIERCE ST # 114
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5246
Mailing Address - Country:US
Mailing Address - Phone:575-513-7696
Mailing Address - Fax:575-208-7223
Practice Address - Street 1:910 W PIERCE ST # 114
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5246
Practice Address - Country:US
Practice Address - Phone:575-513-7696
Practice Address - Fax:575-208-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03066261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health