Healthcare Provider Details

I. General information

NPI: 1447942891
Provider Name (Legal Business Name): WILLIAM JAY SALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/05/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WINDMILL RD
QUESTA NM
87556-0638
US

IV. Provider business mailing address

PO BOX 638
QUESTA NM
87556-0638
US

V. Phone/Fax

Practice location:
  • Phone: 575-586-2014
  • Fax:
Mailing address:
  • Phone: 575-586-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM JAY SALLS
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 575-770-6865