Healthcare Provider Details

I. General information

NPI: 1588454292
Provider Name (Legal Business Name): JENNIFER D EATMON CBPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 SAN FERNANDO DR
LAS CRUCES NM
88011-4164
US

IV. Provider business mailing address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-7501
  • Fax:
Mailing address:
  • Phone: 575-649-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: