Healthcare Provider Details

I. General information

NPI: 1841122975
Provider Name (Legal Business Name): ELIZABETH JADE FLEHARTY DEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RIO ST
RUIDOSO NM
88345-6311
US

IV. Provider business mailing address

206 FORREST LN
RUIDOSO NM
88345-7640
US

V. Phone/Fax

Practice location:
  • Phone: 575-937-5296
  • Fax:
Mailing address:
  • Phone: 575-937-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026002422
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: