Healthcare Provider Details

I. General information

NPI: 1043164254
Provider Name (Legal Business Name): STRONG ROOTS FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 NATIONAL PARKS HWY STE 3
CARLSBAD NM
88220-5697
US

IV. Provider business mailing address

3113 NATIONAL PARKS HWY STE 3
CARLSBAD NM
88220-5697
US

V. Phone/Fax

Practice location:
  • Phone: 575-234-0211
  • Fax:
Mailing address:
  • Phone: 575-234-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DYAN CHAVEZ
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 515-210-3723