Healthcare Provider Details

I. General information

NPI: 1265355077
Provider Name (Legal Business Name): HEALTHY LIFESTYLE EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WEBB RD
FARMINGTON NM
87401-2849
US

IV. Provider business mailing address

930 WEBB RD
FARMINGTON NM
87401-2849
US

V. Phone/Fax

Practice location:
  • Phone: 505-444-0778
  • Fax:
Mailing address:
  • Phone: 505-444-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNA WILLIAMS
Title or Position: OWNER
Credential: CCN, LEHP883
Phone: 505-444-0778