Healthcare Provider Details

I. General information

NPI: 1124446372
Provider Name (Legal Business Name): FHLP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W BLAND ST
ROSWELL NM
88203-5708
US

IV. Provider business mailing address

PO BOX 145
ROSWELL NM
88202-0145
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-2898
  • Fax: 575-627-5721
Mailing address:
  • Phone: 575-622-7337
  • Fax: 575-208-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HANSEN
Title or Position: OWNER
Credential: CNP
Phone: 575-317-4225