Healthcare Provider Details

I. General information

NPI: 1134043060
Provider Name (Legal Business Name): AUTUMN VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MAPLE ST
FARMINGTON NM
87401-5968
US

IV. Provider business mailing address

PO BOX 376
BLANCO NM
87412-0376
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6349
  • Fax:
Mailing address:
  • Phone: 505-330-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91127
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: