Healthcare Provider Details

I. General information

NPI: 1184047631
Provider Name (Legal Business Name): PATRICIA PAINTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E TIERRA BLANCA RD
CLOVIS NM
88101-3753
US

IV. Provider business mailing address

3112 SHELDON ST
CLOVIS NM
88101-3747
US

V. Phone/Fax

Practice location:
  • Phone: 575-366-5030
  • Fax: 575-218-3504
Mailing address:
  • Phone: 575-693-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP03076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: