Healthcare Provider Details

I. General information

NPI: 1508723149
Provider Name (Legal Business Name): JESSICA LYNN CRAIG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 2ND ST 2ND FLOOR RM 6
RATON NM
87740
US

IV. Provider business mailing address

1127 S 6TH ST
RATON NM
87740-4318
US

V. Phone/Fax

Practice location:
  • Phone: 972-900-1871
  • Fax:
Mailing address:
  • Phone: 972-900-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2025-0030
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: