Healthcare Provider Details

I. General information

NPI: 1538153952
Provider Name (Legal Business Name): JOANN BARBOUR COUCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN BARBOUR

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST STE 5A
CARLSBAD NM
88220-3567
US

IV. Provider business mailing address

2402 W PIERCE ST STE 5A
CARLSBAD NM
88220-3567
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-7337
  • Fax: 575-887-5377
Mailing address:
  • Phone: 575-887-7337
  • Fax: 575-887-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number118123
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number118113
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2020-0644
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: