Healthcare Provider Details

I. General information

NPI: 1962985606
Provider Name (Legal Business Name): TYLER BUCHANAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W 21ST ST
CLOVIS NM
88101-4149
US

IV. Provider business mailing address

912 W 21ST ST
CLOVIS NM
88101-4149
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-9000
  • Fax: 575-935-1002
Mailing address:
  • Phone: 575-935-9000
  • Fax: 575-935-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85486
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: