Healthcare Provider Details

I. General information

NPI: 1902860075
Provider Name (Legal Business Name): BARBARA GLORIA WHITTEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W COUNTRY CLUB RD
ROSWELL NM
88201
US

IV. Provider business mailing address

3420 22ND PLACE
LUBBOCK TX
79410
US

V. Phone/Fax

Practice location:
  • Phone: 575-637-7000
  • Fax: 575-637-7019
Mailing address:
  • Phone: 806-725-7800
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR12264
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP00094
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: