Healthcare Provider Details

I. General information

NPI: 1801172150
Provider Name (Legal Business Name): CARRIE NICHOLE BLEVINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 05/24/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W. KANSAS
JAL NM
88252
US

IV. Provider business mailing address

831 CORTO
HOBBS NM
88240-1094
US

V. Phone/Fax

Practice location:
  • Phone: 575-395-3400
  • Fax: 575-395-2235
Mailing address:
  • Phone: 575-691-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01862
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-01862
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: