Healthcare Provider Details

I. General information

NPI: 1215784038
Provider Name (Legal Business Name): JIMENA LAVALLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 N ABILENE PL
PORTALES NM
88130-4813
US

IV. Provider business mailing address

200 MARTIN LUTHER KING BLVD
WICHITA FALLS TX
76301-1152
US

V. Phone/Fax

Practice location:
  • Phone: 575-607-7608
  • Fax:
Mailing address:
  • Phone: 940-766-6306
  • Fax: 940-766-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68082
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: