Healthcare Provider Details

I. General information

NPI: 1417959446
Provider Name (Legal Business Name): CAROL SCOTT CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BARBARA LOOP SE
RIO RANCHO NM
87124-1000
US

IV. Provider business mailing address

13905 AVENUE T
LUBBOCK TX
79423-3235
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8547
  • Fax:
Mailing address:
  • Phone: 505-366-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00136
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: