Healthcare Provider Details

I. General information

NPI: 1912373697
Provider Name (Legal Business Name): LODIE LOY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

172 N EAST PROMONTORY STE 270
FARMINGTON UT
84025-2964
US

V. Phone/Fax

Practice location:
  • Phone: 575-443-6100
  • Fax:
Mailing address:
  • Phone: 801-382-8238
  • Fax: 866-560-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-02750
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: