Healthcare Provider Details

I. General information

NPI: 1194440123
Provider Name (Legal Business Name): CHELSEY DAWN JORDE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST STE B
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

2421 W 21ST ST STE B
CLOVIS NM
88101-2006
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7577
  • Fax: 575-742-7854
Mailing address:
  • Phone: 575-769-7577
  • Fax: 575-742-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69752
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: