Provider Demographics
NPI:1427474568
Name:MOFFITT, MIKI R (RN, BSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MIKI
Middle Name:R
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:RN, BSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LLANO ST
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2172
Mailing Address - Country:US
Mailing Address - Phone:505-334-3404
Mailing Address - Fax:
Practice Address - Street 1:102 LLANO ST
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2172
Practice Address - Country:US
Practice Address - Phone:505-334-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41419163WS0200X
NM85672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool