Healthcare Provider Details

I. General information

NPI: 1578304978
Provider Name (Legal Business Name): MELISSA REYNA APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA TORRES

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

3114 HILLSDALE ST
LAS CRUCES NM
88005-1218
US

V. Phone/Fax

Practice location:
  • Phone: 575-303-2929
  • Fax:
Mailing address:
  • Phone: 915-479-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number62881
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62881
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: