Healthcare Provider Details

I. General information

NPI: 1780778159
Provider Name (Legal Business Name): CONSTANCE C BELCHER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 FRED DAUGHERTY AVE
CLOVIS NM
88101-8615
US

IV. Provider business mailing address

2513 FRED DAUGHERTY AVE
CLOVIS NM
88101-8615
US

V. Phone/Fax

Practice location:
  • Phone: 575-760-0160
  • Fax: 575-762-1676
Mailing address:
  • Phone: 575-760-0160
  • Fax: 575-762-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR19258
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: