Healthcare Provider Details

I. General information

NPI: 1376820688
Provider Name (Legal Business Name): JESSICA NICOLE MYHRE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKI MYHRE DO

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 300
LAS CRUCES NM
88011-8262
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 300
LAS CRUCES NM
88011-8262
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-7600
  • Fax:
Mailing address:
  • Phone: 575-556-7600
  • Fax: 575-556-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60337758
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: