Healthcare Provider Details

I. General information

NPI: 1962714410
Provider Name (Legal Business Name): CLOVIS QUICKCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST STE E3
CLOVIS NM
88101-4093
US

IV. Provider business mailing address

2000 W 21ST ST STE E3
CLOVIS NM
88101-4093
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-2533
  • Fax: 575-769-1735
Mailing address:
  • Phone: 575-769-2533
  • Fax: 575-769-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0383007
License Number StateNM

VIII. Authorized Official

Name: MRS. DEBRA LEE CYPHERT
Title or Position: OWNER
Credential: FNP-BC
Phone: 575-769-2533