Healthcare Provider Details

I. General information

NPI: 1114545142
Provider Name (Legal Business Name): BRITTANY LEIGH HENRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 AVENUE E
CARRIZOZO NM
88301
US

IV. Provider business mailing address

421 WHITE MOUNTAIN MEADOWS DR
RUIDOSO NM
88345-5814
US

V. Phone/Fax

Practice location:
  • Phone: 575-648-2317
  • Fax:
Mailing address:
  • Phone: 903-341-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60519
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: