Healthcare Provider Details

I. General information

NPI: 1437653060
Provider Name (Legal Business Name): CAITLIN THOMAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PECOS VALLEY MEDICAL CENTER 199 HWY 50
PECOS NM
87552
US

IV. Provider business mailing address

12 ENCANTADO CIR
SANTA FE NM
87508-8390
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-6482
  • Fax: 505-757-6968
Mailing address:
  • Phone: 505-501-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03525
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: