Healthcare Provider Details

I. General information

NPI: 1760100606
Provider Name (Legal Business Name): HEALTHY START PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 AVENIDA DE MERCADO
LAS CRUCES NM
88005-4057
US

IV. Provider business mailing address

1745 AVENIDA DE MERCADO
LAS CRUCES NM
88005-4057
US

V. Phone/Fax

Practice location:
  • Phone: 940-594-6415
  • Fax:
Mailing address:
  • Phone: 575-224-5225
  • Fax: 575-224-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANNA KAY LARA
Title or Position: PRACTICE OWNER
Credential: CNP
Phone: 575-224-2552