Healthcare Provider Details

I. General information

NPI: 1659857902
Provider Name (Legal Business Name): CHRISTEN MARIE JANNEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTEN IRBY

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LLANO ST
AZTEC NM
87410-2172
US

IV. Provider business mailing address

PO BOX 6210
FARMINGTON NM
87499-6210
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-3404
  • Fax: 505-334-3486
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996435-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53277
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: