Healthcare Provider Details

I. General information

NPI: 1982007795
Provider Name (Legal Business Name): JESSICA WRIGHT CNP,DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
CLAYTON NM
88415-3304
US

IV. Provider business mailing address

300 WILSON ST
CLAYTON NM
88415-3304
US

V. Phone/Fax

Practice location:
  • Phone: 575-374-2585
  • Fax: 575-374-8146
Mailing address:
  • Phone: 575-374-2585
  • Fax: 575-374-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP02522
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: