Healthcare Provider Details

I. General information

NPI: 1083120760
Provider Name (Legal Business Name): SHANNON L HERNANDEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON L ROPER CNP

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 09/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W CHURCH ST
CARLSBAD NM
88220
US

IV. Provider business mailing address

711 W CHURCH ST
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5211
  • Fax: 575-725-5212
Mailing address:
  • Phone: 575-725-5211
  • Fax: 575-725-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP03456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: