Healthcare Provider Details

I. General information

NPI: 1922106939
Provider Name (Legal Business Name): BILLYE MOFFATT CNFP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/26/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ACOMA CANONCITO LAGUNA INDIAN 80 B VETERANS
ACOMA NM
87034-8703
US

IV. Provider business mailing address

PO BOX 130
SAN FIDEL NM
87049
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax: 505-552-5490
Mailing address:
  • Phone: 505-552-5300
  • Fax: 505-552-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP01035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: