Healthcare Provider Details

I. General information

NPI: 1912633348
Provider Name (Legal Business Name): JESSICA L KLAMMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MAIN ST NE
LOS LUNAS NM
87031-7454
US

IV. Provider business mailing address

328 MAIN ST NE
LOS LUNAS NM
87031-7454
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-5446
  • Fax:
Mailing address:
  • Phone: 505-913-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: