Healthcare Provider Details

I. General information

NPI: 1861323255
Provider Name (Legal Business Name): TAHNIA KNIPP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 21ST ST
CLOVIS NM
88101-4086
US

IV. Provider business mailing address

2001 W 21ST ST
CLOVIS NM
88101-4086
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-1625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number89574
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: