Healthcare Provider Details

I. General information

NPI: 1831818921
Provider Name (Legal Business Name): ROBERT STOOPS CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT STOOPS CNP

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/10/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOSTER LANE
RESERVE NM
87830
US

IV. Provider business mailing address

1 FOSTER LANE
RESERVE NM
87830
US

V. Phone/Fax

Practice location:
  • Phone: 575-533-6456
  • Fax: 575-533-6767
Mailing address:
  • Phone: 575-533-6456
  • Fax: 575-533-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69417
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69417
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR65940
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: