Healthcare Provider Details

I. General information

NPI: 1447253927
Provider Name (Legal Business Name): MICHAEL JEFFREY O'CONNELL CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 S TELSHOR BLVD
LAS CRUCES NM
88011-5029
US

IV. Provider business mailing address

PO BOX 691
MESILLA NM
88046-0691
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7798
  • Fax: 575-522-3415
Mailing address:
  • Phone: 575-636-5019
  • Fax: 575-522-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR37541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: