Healthcare Provider Details

I. General information

NPI: 1902694557
Provider Name (Legal Business Name): JOYCE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MAXFIELD AVE NE
LOS LUNAS NM
87031
US

IV. Provider business mailing address

4617 LOCUST AVE
ODESSA TX
79762-4414
US

V. Phone/Fax

Practice location:
  • Phone: 505-944-6626
  • Fax: 505-359-3239
Mailing address:
  • Phone: 505-730-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: