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General NPI Number Information
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NPI Number | 1104330687
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Entity Type | Individual
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Provider Name | WILLIE BERT MCCORVEY JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 09/14/2025
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Provider Practice Location Address
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Address Line | 2450 S TELSHOR BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88011-5069
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Country | US
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Telephone | 525-522-8641
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 N MESA ST STE A182
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City | EL PASO
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State | TX
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Zip | 79912-4681
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Country | US
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Telephone | 228-238-0260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 78782
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License Number State | NM
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