Healthcare Provider Details

I. General information

NPI: 1528978525
Provider Name (Legal Business Name): JESSIE WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 LOMA HERMOSA DR NW
ALBUQUERQUE NM
87105-1131
US

IV. Provider business mailing address

1435 LOMA HERMOSA DR NW
ALBUQUERQUE NM
87105-1131
US

V. Phone/Fax

Practice location:
  • Phone: 505-369-1731
  • Fax:
Mailing address:
  • Phone: 505-369-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-2137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: