Provider Demographics
NPI:1437040235
Name:TAFOYA-DOMINGUEZ, KELLY JOELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JOELLE
Last Name:TAFOYA-DOMINGUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 HIGH ASSETS WAY NW STE 8
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5115
Mailing Address - Country:US
Mailing Address - Phone:505-261-3050
Mailing Address - Fax:
Practice Address - Street 1:9101 HIGH ASSETS WAY NW STE 8
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5115
Practice Address - Country:US
Practice Address - Phone:505-261-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-202633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily