Healthcare Provider Details

I. General information

NPI: 1629625884
Provider Name (Legal Business Name): CYNTHIA MARIE GAY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S 4TH ST
LOVING NM
88256
US

IV. Provider business mailing address

2602 W RICHEY AVE APT 1202
ARTESIA NM
88210-9660
US

V. Phone/Fax

Practice location:
  • Phone: 575-745-3573
  • Fax:
Mailing address:
  • Phone: 251-751-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57167
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: