Healthcare Provider Details

I. General information

NPI: 1043146335
Provider Name (Legal Business Name): JOHN BRENT CRABTREE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W COUNTRY CLUB RD STE 13
ROSWELL NM
88201-5804
US

IV. Provider business mailing address

313 W COUNTRY CLUB RD STE 13
ROSWELL NM
88201-5804
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-5828
  • Fax:
Mailing address:
  • Phone: 575-627-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number90067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: