Healthcare Provider Details

I. General information

NPI: 1750984993
Provider Name (Legal Business Name): DESERT SKY FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W. BOUTZ RD. BLDG. 8, STE. 4
LAS CRUSES NM
88005
US

IV. Provider business mailing address

205 W. BOUTZ RD. BLDG. 8, STE. 4
LAS CRUSES NM
88005
US

V. Phone/Fax

Practice location:
  • Phone: 575-222-4042
  • Fax: 575-288-1290
Mailing address:
  • Phone: 575-222-4042
  • Fax: 575-288-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ROSE LYNCH
Title or Position: OWNER
Credential: NP
Phone: 575-222-4042