Healthcare Provider Details

I. General information

NPI: 1841186418
Provider Name (Legal Business Name): ELIZABETH ANN HENDRICKS MSN, APRN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN HENDRICKS BETH HENDRICKS

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CALLE DE ALVAREZ
LAS CRUCES NM
88005-3821
US

IV. Provider business mailing address

1649 NELEIGH DR
LAS CRUCES NM
88007-1985
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-3346
  • Fax:
Mailing address:
  • Phone: 575-571-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number84537
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: