Healthcare Provider Details

I. General information

NPI: 1013802156
Provider Name (Legal Business Name): GAYLE RAYE BASSETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GAYLE RAYE GLENN

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N PEARL ST
DEMING NM
88030-3835
US

IV. Provider business mailing address

111 N PEARL ST
DEMING NM
88030-3835
US

V. Phone/Fax

Practice location:
  • Phone: 575-517-2725
  • Fax:
Mailing address:
  • Phone: 575-571-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84397
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: