Healthcare Provider Details

I. General information

NPI: 1568712842
Provider Name (Legal Business Name): WILLIAM JAY SALLS CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY SALLS MSN/FNP-BC

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 04/22/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SOUTH LATIR ROAD
QUESTA NM
87556
US

IV. Provider business mailing address

PO BOX 638
QUESTA NM
87556-0638
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-6865
  • Fax: 833-450-5253
Mailing address:
  • Phone: 575-586-2014
  • Fax: 833-450-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0000331-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02608
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: