Healthcare Provider Details

I. General information

NPI: 1669864120
Provider Name (Legal Business Name): REAGAN MYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5069
US

IV. Provider business mailing address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5069
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-4432
  • Fax: 575-532-4431
Mailing address:
  • Phone: 575-532-4432
  • Fax: 575-532-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01356
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: