Healthcare Provider Details

I. General information

NPI: 1447849344
Provider Name (Legal Business Name): COURTNEY SLIGHTAM RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CAMPO RD
TIJERAS NM
87059-7615
US

IV. Provider business mailing address

40 CAMPO RD
TIJERAS NM
87059-7615
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-0711
  • Fax:
Mailing address:
  • Phone: 505-604-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number57598
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: