Healthcare Provider Details

I. General information

NPI: 1447809884
Provider Name (Legal Business Name): ANTHONY VISCON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

IV. Provider business mailing address

841 GOLD BEACH DR
CANUTILLO TX
79835-8466
US

V. Phone/Fax

Practice location:
  • Phone: 575-249-2225
  • Fax:
Mailing address:
  • Phone: 915-630-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP142909
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number62727
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP142909
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP142909
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP142909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: