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NPI Code Detail

MEDICARE: JORDAN MARIE WEATHERLY

MEDICARE: JORDAN MARIE WEATHERLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorCTB-2025-0423NM

General Provider Information

NPI Number : 1265275572
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MARIE WEATHERLY
Provider Business Mailing Address
First Line : PO BOX 405
Second Line :
City : SAN MIGUEL
State : NM
Zip : 88058-0405
Country : US
Telephone Number : 575-323-1315
Fax Number : 833-524-5203
Provider Business Practice Location Address
First Line : 2435 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5029
Country : US
Telephone Number : 575-323-1315
Fax Number : 833-524-5203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2024
Last Update Date : 03/19/2026

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Directions to “ JORDAN MARIE WEATHERLY ” Practice Location

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