Healthcare Provider Details

I. General information

NPI: 1902398209
Provider Name (Legal Business Name): DAVIN C CRAIG DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SPRUCE ST STE CANDD
ESPANOLA NM
87532-3455
US

IV. Provider business mailing address

835 SPRUCE ST STE CANDD
ESPANOLA NM
87532-3455
US

V. Phone/Fax

Practice location:
  • Phone: 575-747-7400
  • Fax:
Mailing address:
  • Phone: 505-747-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-03535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: